Melbourne HIFUMinimally Invasive Prostate Cancer Ablation Treatment

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FAQ
HIFU ENQUIRY
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Introduction
Personal Details
Prostate History
Medical History
Additional Information

Patient HIFU For Prostate Cancer Enquiry

If you are interested in HIFU treatment, please complete the following questionnaire.

A/Prof Royce will review your submission and reply accordingly.

Begin Questionnaire

First Name

Last Name

Date of Birth

Country of Residence

Email

Mobile Number

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Number of biopsy cores involved with prostate cancer

Highest Gleason Score on Prostate Biopsy

Current Prostate Volume (cc)

Current PSA

Have you had a prostate MRI scan ?

Yes No

Have you had a PSMA PET scan ?

Yes No

What is your current plan for treatment ?

Active Surveillance Surgery Radiation Therapy Brachytherapy

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Have you had a Previous TURP ?

Yes No

Have you had previous prostate radiation therapy ?

Yes No

Have you had previous hormonal therapy ?

Yes No

Have you had coronary heart disease ?

Yes No

Have you had previous rectal Surgey ?

Yes No

Are you on anticoagulation therapy ?

Yes No

Do you have a latex allergy ?

Yes No

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Additional Information

Please attach relevant documents (eg. Biopsy Histopathology, MRI scan etc..)

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