Treatment with new technology

[rfarley01]

I have known for over 8 years that PCa had showed its ugly self to me. After given the news by my urologist, since 1983( previously treated for kidney stones), he gave me the textbook "cut, radiation an poison" talk. My first question was "What would you do, Doc?" He said " If I were you, get several other opinions, but I"d watch it an do a check every year. You'll probably die with it, than from it." Since that time, he has retired an I have said NO to several other doctors that insisted on treatment immedietely. Forward to present: the gleason number changed from 3/3=6, 3/4=7 to spring 2018 4/3=7, I decided it was time to do something. I had been looking at HIFU then scheduled a single high dose brachytheropy but at the last minute cancelled when my research came across Radiologist Dr Dan Sperling in Delray Beach, Florida. His speciality is FLA (focal laser ablation) He said "if I can touch it to biopsy, I can touch it with laser an get rid of it. My out patient procedure lasted almost 3 hours on June 26. I go back in 6 months for a check-up. RF

[Tall_Allen]

I would caution anyone interested in following your lead that there are many unresolved issues wrt focal ablation:

pcnrv.blogspot.com/2016/12/...

That said, I hope this works out for you. Continual monitoring is important.

[AlanMeyer in reply to Tall_Allen]

I had a look at Tall_Allen's blog post cited in his reply to rfarley01's posting. As I've come to expect from Allen's postings, it's very thorough and deeply informed. It should give pause to anyone considering focal ablation.

One of the tendencies we patients have is to assume that the latest techniques are better than the older techniques. After all, aren't they based on the latest research? Aren't the latest computers and phones better than the older ones? Isn't new technology better than old technology?

But in medicine it doesn't always work that way. We have easy ways to test a new computer and only the ones that pass the tests and are faster, cheaper, and/or more reliable than the old ones get into the market. However medical procedures are not so easy to test. They require expensive and long running multi-year clinical trials. Furthermore, a lot of the new medical procedures are not as fully understood as the old ones. It may take years of experience before the doctors learn the best ways to use them. Being conservative about choices of treatment can be safer than going with new technologies.

Alan

[rocket09 in reply to Tall_Allen]

Thanks for that info. My MRI showed a tumor at the outer edge with a DWI of 4 and I have a Gleason 6 . I am scheduled for a robotic prostatectomy but was thinking on the sperling laser. I am concerned that if it grows outside the prostate it could be worse for me in the long run.

[rfarley01 in reply to rocket09]

I strongly advise you to talk to them before you do that total surgery.

[Tall_Allen in reply to rocket09]

Have you looked into SBRT? It treats a margin outside of the prostate, and has a very low side effect profile.

[rocket09 in reply to Tall_Allen]

Yes but they don't do it in my province and medical wont cover it. My urologist says it is still focal and I think RRPS? is the best option for me . He says it should be a cure with least after effects. In Canada the 6 + weeks of radiation is still the standard of care.

[rocket09 in reply to Tall_Allen]

Do you like the radiation better than the operation?

[Tall_Allen in reply to rocket09]

No, SBRT is certainly not focal, it is radical. What is RRPS? What province? I know SBRT and HDR-BT are available in Toronto. LDR-BT is available in BC.

[rocket09 in reply to Tall_Allen]

I did not know the abbreviation for robotic radical prostatectomy. Maybe he meant local as the tumor is still inside the prostate. I thought he said focal. I am in Alberta. One of ten countries inside Canada as far as healthcare goes. Lol. Sorry for the confusion.

[AlanMeyer in reply to rocket09]

I was diagnosed 15 years ago with a Gleason 4+3 cancer on both sides of the prostate and with at least one tumor visible on MRI that extended through and outside the prostate. I was treated with a combination of HDR brachytherapy (for the prostate itself and for a tumor extension that showed up on MRI pushing outside the prostate), external beam radiation (for the area 1 cm around the prostate), and Lupron. I had a lot of PSA bounces up and down and it took more than 5 years to reach nadir and even bounced once more at 7 years. But so far I've had no other treatment and my last PSA was 0.07.

I don't think there's anything magical about the specifics of my treatment, but I do think, as Tall_Allen says, that radiation can target tumors around the prostate as well as inside it. The SBRT that he mentioned may be better than what I had.

I do think that, whatever therapy you get, be sure to get it from the best doctor available to you. Whether the doctor is using a scalpel, a robot arm, an x-ray beam , a proton beam, radioactive seeds, or whatever, it is essential that he employ his tools with high precision and high accuracy, that he really knows what he is doing, and that he's committed to doing the best job for you that he can.

Best of luck.

Alan

[rocket09 in reply to AlanMeyer]

Thanks

[rfarley01 in reply to rocket09]

Rocket, you really need to do your research before taking the path of any type of radiation. Its affects can be just as permanant an debilitating as total removal, so I'm told from guys that have done it. Pca can grow back even after total removal, Ive lost 2 coworkers who had a tterrible post surgery then reoccurance within 2 years. I went with the least invasive first, that is able to be retreated but mostly leaving me more whole body intact an functioning. You should qualify for FLA no matter the prostate size.

[rocket09 in reply to rfarley01]

Thanks, I have a email sent to the Sperling center

I hope to hear from them. I will be open minded. I appreciate your help.

[BeachChuck]

Hi RFarley01. I had HIFU 2 years ago if you want to talk to me. I have no regrets even with insurance not covering it.

[rocket09 in reply to BeachChuck]

I don't qualify as my prostate is too large.

[rfarley01 in reply to BeachChuck]

Chuck, the newest an more procise is the MRI guided, live image HIFU Its available in limited areas Ive already had the FLA procedure. Next week will be 1 month post

[Portugal-2]

Thank the

[rfarley01]

MRI-Guided Focal Laser Ablation for Prostate Cancer - UChicago ...

uchospitals.edu/specialties...

A. Potential advantages of MRI-guided focal laser ablation therapy for prostate cancer include the following: Lower risk for side effects such as urinary incontinence, impotence and decreased bowel function, as compared to surgery or radiation therapy.

‎What are the benefits of MRI ... · ‎Who is a candidate for MRI ...