I looked into HIFU rather carefully (at least for me) and when my Gleason was 3 + 3 I planned to go to Toronto and have HIFU done by Bill Orovan at his clinic there. The web site is www.hifu.ca Orovan is head of surgery at McMaster University in Hamilton Ontario, one of Canada's leading medical schools, and was trained at M.D. Anderson. I knew two doctors, one who was with him at Anderson, and one who had worked in the O.R. with him here in Canada, and both spoke highly of him. If you decide to call ask to speak to Janice. Janice is a nurse, seemed very knowledgeable, was generous with her time on the phone, I never felt pressured at all, and she is also Bill's wife.
The cost was about $20,000 U.S. and it is an outpatient porcedure. The hotel they book you into is a couple of blocks away from the clinic. You walk over in the morning, and walk back that afternoon. The next day you fly home.
Best I could tell from talking to various doctors and from reading on the internet the short term stats for HIFU were as good as the short term stats for surgery. Long term stats are not available for HIFU. It hasn't been around long enough.
One thing I liked about HIFU was that a treatment didn't rule out any other future treatment, including a second HIFU or a da Vinci prostatectomy. I spoke to a surgeon who had removed a prostate via da Vinci after two HIFU treatments had failed to keep the PSA down.
All is not roses, however. It never is, is it? The treatment, as you'll learn, is not approved by the FDA in the U.S. but is approved in Canada by our equivalent of the FDA. There are possible complications with HIFU, just as there are with any treatment. I'd not want to minimize them at all, but best I could tell issues were likely a little less than with surgery. Comparison is difficult because experience of the doctor is a critical issue, although probably less so with HIFU as it is very computer dependent for generating the proposed treatment plan which is approved by the doctor. I spoke with one doctor, who doesn't do HIFU, but had sat in on several HIFU sessions to learn about it and he said that unlike surgery where the surgeon is working all the time, with HIFU the doctor can be sitting, having coffee, chatting away, while the computer and the HIFU probe do their work.
My HIFU plans were short circuited by a reread of my biopsy slides which said my Gleason was 3 + 4. No reason to think the second read was any more accurate than the first, and the 3 + 4 was everybit as acceptable a Gleason to have treated by HIFU as the 3 + 3 was, but one downside --- at least for me --- is that with HIFU there is no prostate to do pathology on afterwards. A HIFU advocate would say, so? What difference does it make. Once your prostate is out it isn't pathology that matters, it's your PSA. But, I knew if there was a possibility I was a Gleason 7, that I might have some "4" cells, I wouldn't be happy without the pathology afterwards. So, off I went to dance with da Vinci.
I made absolutely the right decision, for me. And I was lucky. My surgery went well, my recovery was not a problem, I'm doing well with a zero PSA after six months, but if I had a second prostate to give to medical science, knowing everything I know about HIFU and surgery now, I might be more inclined to opt for the HIFU. The reason is that now that I have the pathology, and have been reading this group for a much longer period of time, I better understand that my "excellent" pathology is all very nice, but it is what it is, and the only thing that matters is my PSA. The pathology may be a fine leading edge indicator of what may, or may not, happen with my PSA but that's all it is --- an indicator.
But, it's easy to think if I knew then what I know now I might have made a different decision. Fact is a radical prostatectomy is the gold standard for PCa if the PCa is organ contained and the long term stats are available for surgery, and they're not for HIFU and I'm a conservative kind of guy who likes to cover his bets, so in a real life situation I might still opt for surgery.
I tell you all this to acknowledge treatment decisions are not easy ones. I found the worst part of having PCa so far was making the treatment decision. Once that was made I felt a huge weight lifted. I still feel good about my decision and don't regret it for a moment but if I had to do it over again, knowing then what I know now, I'm not sure what I'd do.
Good luck for whatever course of action you decide on. I hope you'll keep posting and let us know where you're at and how things are going.
Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours. Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn --- perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
First post op PSA Sept 09 less than 0.02
PSA on Oct 23 test again less than 0.02
PSA on Jan 8 less than 0.02
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7