Rog T's cancer blog - decision day HiFU or Surgery

For those of you who are regular readers and have read the previous posts on Cancer, you can skip this first paragraph.This is the latest installment in my occasional series about how I'm adjusting to living with a big C in my life.  For those of you who aren't, here's a quick summary. I'm 51 years old and in October 2011 I  had a prostate biopsy following two "slightly high" PSA tests - 2.8 & 4.1. The biopsy took ten tissue samples and one of these showed a "low grade cancer" which gave me a 3+3 on the Gleason scale. I'm now on a program of active monitoring.  In early February, I got the results of the a PSA test - down to 3.5 and an MRI scan which found absolutely nothing, two more tests in 2012 were at 3.5 and 3.9, in 2013 my test was 4.0, Jan 2014 was 3.8, August 2014 was 4.0,  February 2015 it was  up to 5.5  and my latest in August 2015 was down againg at 4.6. In October 2015 I had a transperinial Prostate biopsy, that revealed higher grade cancer and my Gleason score was raised to 3+4 (Small mass + more aggressive cancer), albiet with small mass. I've no symptoms and sadly for a few people, if I'm gonna die soon, it won't be from Prostate cancer. Got the picture?

In October I got some rather unwelcome news. I received the results of a transpereneal biopsy that showed some of the cancer was Gleason 3+4, as opposed to the less aggressive 3+3 previously diagnosed. As this was the first time I had this procedure, which is more accurate, it didn't necessarily mean that the prostate cancer had developed. It is just that this form of biopsy is more accurate. I had three treatment options. Surgery, radiation or HIFU (a new ultrasound treatment). First up I met the Oncologist who discussed radiation options with me. His recommendation, given my age was that I do not go for this option. At 53, the possible long term side effects are far more risky than for an 80 year old.

Next up, I saw the surgeon. His recommendation was that I don't muck about and have a radical prosateectimy. He said this would make the problem go away for once and for all. The down side? A high risk of incontinence, impotence and infertility. Infertility is not the end of the world for me. I have three lovely kids and can't really see any situation where I'll be having any more. Impotence and incontenence are a different matter. For me, this is a real issue. Following the operation, I would be unable to ejaculate, however there is a physical sensation of orgasm.This is something I don't really understand, however my surgeon assurred me that this was something that was not an issue for most men. Approx 7 out of 10 men are able to get an erection following the surgery. It all depends on nerve damage during the op. The surgeon explained that the surgery I had would most likely spare the nerves, however "things happen sometimes". As for the incontenence, you need to do pelvic floor exercises and the majority of men are continent after three months. I explained that my preference would be for HiFU if possible. My surgeon felt that with my prognosis, I'd not be suitable for HiFU, which is still in the trial stage. He explained that the distribution of the cancer made it a less than optimal treatment. Following this discussion, I had mentally decided that I'd have to come to terms with surgery. I did however decide that if the HiFU team would see me, I'd have a chat.

So today, I found myself in the UCH with the HiFU team. My surgeon had more or less convinced me that this wasn't a go'er, but you should always keep your options open. Much to my surprise, my consultant took a rather different view to my surgeon. He explained the procedure and said that the team had assessed my case and felt I was suitable. Unlike surgery, there would be regular follow up. He said that if I could cope with the ongoing biopsies etc, then it would be an option. Of course, as the prostate was still there and they wouldn't be addressing all of the low grade 3+3 cancer cells. His view were that these could be monitored, so in effect I'd be back on active surveillance. Having lived with this for four years, I am comfortable with this. So I've opted for the HiFU. Whilst this doesn't offer the prospect of the issue completely going away. It does however mean that hopefully the quality of life issues can be postponed. This may be indefinately or it may just be for a few years. That is a risk I am prepared to take. I can always have the prostate removed later if the cancer again becomes more agressive.

In some ways it is Hobsons choice. Complete cure/Bad side effects risk vs Higher long term risk/less side effect risk. For me, with my current lifestyle, this is clearly the right decision. It looks like the treatment will take place in January. I will be out of action for about 10 days if all goes well. No football for a month. I can live with that. As HiFU is a relatively new treatment, I guess this will be of interest to a few people in a similar situation. I would urge anyone not to be put off by what the surgeons may tell you and if you want to explore HiFU have a chat with the team.