HIFU, my experience

My husband had HIFU in 2006 as a secondary form of treatment. He had RT in 2000 and the cancer recurred in 2004.

He paid for it privately as the PCT would not fund further treatment. ********. It failed as it was subsequently discovered, by MRI, that the recurrence was in the seminal vesicle. As I understand it, cancer in this area cannot be treated.

In my area of East Surrey, HIFU is not recommended as a primary course of treatment.  It is alleged that many men have died as a consequence of having primary HIFU instead of the conventional RT. This has been widely reported in newspapers.

Edited by moderator 03 Aug 2018 at 18:46  | Reason: Named Consultant

Hi Rick,

As I said when I started this thread, HIFU can be given (to suitable men) as original radical treatment or as a salvage treatment for failed RT. (again for suitable men). In both situations the cancer should still be contained within the Prostate. Results are better if there is only a small amount of cancer and on one side only. Very few hospitals/medical facilities offer HIFU in the UK, although more are introducing it.

If a man decides to have HIFU as a primary treatment he makes the decision in preference to having a traditional treatment such as a form of surgery,radiation or even other forms of lesser established treatment such as Cryotherapy, Nanoknife IRE or FLA for example.The advantages of having this as a first line treatment are that the procedure is quickly performed with generally lesser side effects, particularly where only a small part of the Prostate, which must be accessible for the HIFU probe to focus on, needs to be ablated. It is also possible in need to repeat the HIFU. (It may be possible to have salvage Brachytherapy following failed HIFU, I didn't research this as HIFU was not my first line treatment.) Certainly, HIFU has improved over recent years but long term results are not yet well known. I believe that Brachytherapy is a more proven treatment and where appropriate can be augmented by EBRT as part of the treatment.

HIFU as salvage treatment for failed RT is a quite different situation. Usually, the man has had his full dose of RT largely to his Prostate and Prostatectomy thereafter is very difficult with high risk of incontinence and ED to boot. Therefore, if the cancer is still within the radiated Prostate, HIFU or another way of treating the Prostate with focal treatment means that it is possible to avoid HT, Chemo and other down the line treatments that work systemically, when only really the Prostate needs to be treated.

I have not added to this thread for some time now as I have posted my situation elsewhere. However, as it has now been referred to I will update. HIFU was administered where one only core of a template biopsy showed a tumour. There was some doubt about another area within the Prostate that might have cancer but this was not ablated. There was also doubt about cancer being in an iliac node. I think the operation went well in treating what was intended, However, my PSA continues to rise, albeit slowly, and a private PSMA scan has confirmed that there is a small tumour in another part of my Prostate. which I am hoping will be treated with further HIFU or if this is too difficult with Cryotherapy. UCLH are reluctant to repeat HIFU saying my Prostate has already been subjected to two radical treatments. I have a telephone appointment with them on 31st July to hopefully get a final decision on this as otherwise I will look to get this done privately---ouch! The PSMA scan showed no pelvic involvement or anywhere else outside the Prostate so why settle for HT or any other systemic treatment at this stage I argue? 

My urinary function remains as pre HIFU and nothing else has changed so far, nearly 3 years on.

Newspapers often dramatise but if correctly reported, the Professor quoted in this article and the lady doctor C M who administered my HIFU are upbeat on the subject of HIFU (High Intensity Focal Ultrasound) http://www.dailymail.co.uk/health/article-5921047/Ultrasound-just-effective-surgery-radiotherapy-prostate-cancer.html

Edited by member 25 Jul 2018 at 01:14  | Reason: Can't get link to highlight without editing - always the same

Thank for for posting again which I and I am sure others appreciate in your sad circumstances. You are right; it is a complicated subject and also a sensitive one, often with unpredictable outcomes whatever the treatment. The chances of a successful outcome are certainly improved by having a good team on your case preceded by high quality tests/scans and interpretation of these. and good follow through. (A number of times we have heard with regard to breast cancer for instance which always seem to be considered more newsworthy, that those who assess scans have got it wrong and women have to be recalled). A similar situation must apply to men when their scans are misinterpreted and heavily relied on by those administering treatment. Also, even the best scans do not always show the true extent of the cancer. My own case illustrates this. UCLH believed the uptake of Choline in an iliac node after HIFU indicated cancer but I had this scan viewed by 3 other hospitals and none of them were convinced this was the case. I subsequently had a PSMA scan done elsewhere and it was reported by the hospital that there was no evidence of any cancer outside the Prostate but some still within it. So whereas UCLH just wanted me only to be treated with Hormone Treatment, there is now the possibility of further focal therapy to deal with this other cancer in my Prostate. This illustrates the importance of scan interpretation and of high quality scans. Of course biopsy findings are also important to assess whether the cancer within the Prostate can reasonably be left or is aggressive and needs to be specifically targeted. So sometimes the team get it wrong and not necessarily through negligence but because the tools available to them are not good enough. This is just one aspect but an important one. We here are not competent or in a position to comment on the actual quality or how appropriate HIFU was in the circumstances but as you said, the surgeon was not authorized to do the op so is at fault in that regard at least.

HIFU and indeed other forms of focal therapy can be suitable in certain cases and particularly as salvage treatment for failed radiotherapy but has it's limitations.

Didn't have any clinical involvement with any lady except C M (surname of former male England football captain), who did the HIFU procedure.