I wanted to further update you with information about HIFU and there are different approaches that can be taken with the treatment. The most typical treatment over the years has involved treating the entire prostate gland but with new diagnostic technology that can give more confidence in localized disease (particularly disease that may only be in the left lobe or the right lobe as opposed to both) is more readily available.
The classic prostate biopsy is done in the office transrectally with ultrasound guidance and 12 samples are taken. If prostate cancer is found in only one lobe on this type of biopsy there can only be limited confidence that cancer truly is that limited due to the relatively small sample size of 12 cores. If treatment of only one lobe is being considered with HIFU after a 12 core biopsy we will usually obtain a multi-parametric MRI of the prostate to add certainty that the disease is limited.
Another way of better characterizing the extent of disease is with a Transperineal Mapping Biopsy which includes samples taken about every 5mm throughout the prostate and is done under general anesthesia in a hospital or surgery center setting. This is sometimes done in patients who have a rising PSA or abnormal MRI after having a prior negative 12 core biopsy. It can also be done after a positive 12 core biopsy for better staging.
Treating less than the entire prostate with HIFU is still considered a new approach but 5-year results published in 2018 in the European Journal of Urology showed excellent results and minimal side effects. Recovery is usually quick and straightforward with full gland treatment but even faster with partial gland treatment. This approach OR full gland treatment can also be an option for patients who may not have had complete success with other treatments in the past such as radiation.