Re: Radiation after HIFU and Surgery
I'm so sorry to hear that you've gone through all that. I looked at my files on the subject (I'm a little nuts about keeping files) and could only find one study that was at all relevant. This one, from France, looked at the effect of salvage radiation after HIFU failure (but not after salvage RP too). 5-year progression-free survival after the salvage radiation was 93% for low risk (Gleason 6), 67% for intermediate risk (Gleason 7) and 55% for high risk (Gleason>7) cases. There were a few cases of bad urinary outcomes - 7% had grade 3 or worse urinary side effects, and a lot of impotency (only 17% remained potent.). Here's an abstract:
Your PSA hasn't shot up very high, so it is likely that the cancer hasn't escaped the local area and is hiding somewhere in the prostate bed. What was your RP Gleason score? I'm assuming it was low and they suspected at the time that it was still confined to the prostate or they wouldn't have tried a prostatectomy. I'm also assuming your nodes were negative, and if you had a bone scan, it was negative too.
I suspect the reason your doctor is hesitant to give you radiation on top of HIFU and RP is because there is so little known about such treatment and the potential urinary side effects may include incurable incontinence, urethral strictures or a urinary fistula. The salvage radiation doesn't just hit the prostate but the whole area around your prostate, including the urethra, bladder and rectum, all of which have already been stressed by your two previous treatments.
Have you talked to your doctor about hormone therapy?
Another option worth consideration is trying to find exactly where the cancer is. If you knew where it was, you could pick it off with radiation or other ablative techniques. Finding it is very difficult, perhaps impossible, with someone with your relatively low PSA, because there is probably not big enough a mass to show up with current imaging techniques. C11 Choline PET scans are probably the best, but are almost impossible to come by. Also rare is feraheme MRI and I don't know how good it is at finding tiny bits of cancer in the prostate fossa. Multiparametric MRI, NaF18, C11 Acetate, and F18 Choline PETs will almost certainly not be sensitive enough, although it may be worth a try if your radiologist is willing, perhaps with a fused image. The other imaging techniques, color doppler ultrasound and elastography, have so far only been used within the prostate, to my knowledge. I'm just tossing out ideas here. A good radiologist, perhaps at an important teaching hospital, might be willing to take on the challenge.