Focal HIFU

Thanks Lynne

i had to wear a mask at the hairdresser and agree it was vile ( hats off to the medics working in full PPE)

i shouldn’t ask about your brain but mine is a left temporal shunt fitted when I was 35 following rupturing an arachnoid cyst i didn’t know I had on a  flight to New York.

only the one MRI for me in the USA .. monitored via CAT scans.

 Couldn’t but be interested in your comment! 

Back to PCa ., 5pm zoom consult. I am not being particularly effective today! 

Thanks Barry

the suspicious area is in the area he had the HIFU. It is close to the Apex and she was non commital re next steps other than:

1. Get an immediate urine test ( done - hope to get results tomorrow but not expecting that to be the issue

2. Got added to 31st July biopsy list ( he has to start to self isolate from Friday as hospital is COVID free. 

She wants biopsy results before discussing next step but we are accepting the likelihood that an RP will be recommended and if so will accept it - we have met the surgeon experienced in removal following a focal treatment and he uses Neuro- safe so hopefully nerves can be saved in full confidence.

we have known for 2.5 years that this maybe where we end up and heigh- ho. It’s a very quick increase from 1.31- 1.6 . A still is 100% symptoms free. He was in office for first time today which he enjoyed. He is 57, fit and healthy and it seems weird to think we have to injure him to keep him safe.. 

So if urine test is negative my understanding is no further PSA but direct to biopsy. Do you think we should ask for a confirmatory PSA? 

Thanks Barry

Clare

It seems to me that CM feels it is highly likely that the suspicious area is cancerous and I don't think 'A's PSA moving up or down slightly before the biopsy would make any difference. However, should the urine test prove to be positive, it would seem prudent to treat this and then have a PSA test. The biopsy could be deferred until this was done and it could be established whether the infection was responsible for the rise.

However, I would try to get confirmation, (as well as can be ascertained from biopsy following on from the MRI), whether the cancer is still well contained so a RP stands a good chance it would remove it all.

For some, focal treatment does the job or for longer than it worked for 'A' and it has been given a good chance but I understand there is a limit to the number of times a man is prepared to get tumours treated piecemeal.

Thanks Simon

The prof you mentioned and the alternative approach is on my list of research topics! A has had 2 focal treatments and the guy who specialises in removing ‘focal fails’ does have great stats.

Barry - good point we need to know if it’s still contained. It was us who pushed for the earliest biopsy date due to a break planned early August so she didn’t seem concerned if we had waited till September. I think this question is worth an email to her and also we haven’t had the MRI report. 

So today ( both WFH)  we walked to our local for our first post full lockdown lunch. Beautiful weather, lovely lunch. Walking back past the GP reminded us we needed to ring for results and did so as we walked back. As expected the urine test has come back negative so self isolation begins tomorrow heading for the third biopsy. He rang each of our children after we heard no infection. We are very lucky to have a fantastic ‘pigeon pair’ and blessings are very much being counted! 

Clare

Thank you Lyn, yes we are pleased with the 2 1/2  years we have had since initial diagnosis.

Biopsy number 3  yesterday and he is home now. Self isolating for 2 weeks was worse than the biopsy so lovely to ‘have him back fully!’

He has now seen the MRI which does have a very small but quite ‘white spot’. She took ‘ many samples’ he says. I say ‘ how many? ’, he says ‘ oh I didn’t ask!’ ... 

Results 9am Thursday is quicker than I remember fon the previous two. Biopsy 3  is showing no bruising  or pain and all is functional unlike biopsy 1 where he was black and blue and recovery took some time.

Back to waiting! 

Clare

Sounds like relatively good news as you say. Enjoy the break. Better to be on the roads today I suspect than nearer the weekend :-)

TG

It seems the tumour is very small like mine, (as a small grain of rice I was told from MRI). Before doing my last biopsy, the surgeon told me that being so small he would do well to hit it but in the event managed to do so as the Grade given was 3+4 as has been in previous biopsies. Interestingly, my PSA fell thereafter and it seems to me it was likely that this was because some of the tumour was removed in the core, smaller tumour less PSA. One wonders if a considerably larger needle could be used to remove all of the tumour but perhaps this is technically too difficult to do.

Prof E and his team are at the top of their game. Hope everything goes well and you can get on with relative normality after surgery.