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Re: hifu salvage treatment

G'day William,

It seems that you are British, so I also assume that the dates of your PSA are October 9 and November 10 (and not September 10 and October 11 as they might be interpreted by a US resident). Either way, if the figures are verified, a doubling of PSA in a month is not likely to be good news. By being verified I mean that

(a) you are certain that both results were done by the same laboratory using the same methodology;

(b)there were no extraneous events (such as sexual activity) that could have influenced the results;

(c) the possibility of laboratory error has been ruled out - this is usually done by having another PSA test to see if the results match.

In my opinion these actions should always be taken before any decision based on PSA is made about therapy.

I was intrigued by your reference to an MRI scan revealing a growing lesion. Can you give us a bit more detail on this? MRI scans are notoriously unreliable for identifying small tumours, so the implication is that yours must be larger already. Was there any lesion prior to your two (or is it three) therapy bouts? Is the lesion in the area where the HIFU was aimed or outside that 'target area'? If it is in the 'target area' of previous treatments, can you be sure that it is not a side effect of the therapy - for example, scar tissue caused by the HIFU? Did you have two or three HIFU treatments until now?

What is Professor Emberton suggesting - and why. What data or studies does he show you to support his recommendation? I ask this because HIFU is still regarded as 'experimental' in many countries and it is even more difficult to find studies on HIFU than some other options. I haven't searched specifically for salvage options for failed HIFU, beyond noting that the manufacturers of the machinery claim that the therapy can be repeated many times. But there must, surely, be some dmage to the gland itself - the tuour could not be destroyed without collateral damage to surrounding tissue. Does this mean that surgery for example is ruled out as an option - as it is in most cases for failed radiotherapy?

I think these questions, and any others that might be suggested to you should be answered before you make your decision. Presumably Professor Emberton has the answers to this type of question and I'd be grateful if you could share them with us when you get them.

Good luck,
Terry in Australia

Re: hifu salvage treatment

It may be worth reading this comment on a new study on salvage HIFU New data suggest that salvage HIFU after EBRT is “a high-risk procedure”

Terry in Austarlia

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