Would non-curative cryo buy me time before ADT?

[yeatz]

Feb. 27, 2019

from yeatz: Just found out my recurrent PC is beyond curing.

My EPE, penetration into seminal vesicles, & Gleason 8 put curative

treatments out of reach. Docs recommend the usual: ADT.

But: I HATE Lupron! Very bad fatigue, depression, cognitive problems

in 2 years on it before. Docs & med sources have produced ideas.

QUESTION: Do any of these make sense?

-- Cryo, destroying as much PC tissue as possible. Doc says this could

buy me extra 2-3 years before needing ADT.

-- In Europe, they take Casodex till it stops working. For 1-2 years, no side effects

from lack of testosterone. Only THEN start ADT.

-- Slightly lower dose of Lupron (or other LHRH agonist), so maybe 5-10%

of testosterone is still produced? Slower reduction of tumor, but maybe

fewer ADT side effects.

You guys know a lot! Help is much appreciated.

[GP24]

Allan recommended salvage brachy or SBRT to your last post. I think this are better alternatives than cryo. You can add adjuvant Casodex then which will probably work for a long time once the recurrence has been destroyed.

[yeatz in reply to GP24]

Unfortunately, my previous radiation treatment (75.6 GY, external)

has made it too dangerous to put more radiation into that area:

Lots of scar tissue, minor urinary & rectal problems from earlier treatment.

Your ideas are good ones; wish I could go with them!

[Tall_Allen in reply to yeatz]

75.6 Gy is not a high dose for primary radiation; in fact, it's lower than contemporary standards (which may explain your recurrence). MSK and Mayo have found that most failures after radiation are salvageable:

pcnrv.blogspot.com/2016/09/...

pcnrv.blogspot.com/2016/08/...

The idea behind focal salvage radiation is that you are not putting it "into that area," but only where the cancer has recurred.

If scar tissue is a problem now, cryo will make it worse.

[GP24 in reply to yeatz]

Brachytherapy and SBRT can be applied if the area had been radiated before. SBRT allows to radiate very small spots with a high dose. So you can just destroy the recurrence area.

However, you will have to talk for advice to doctors who have these machines available and not to the ones who have never used these.

[Survivor1965]

I’ve done cryoablasion twicespine, ribs, and it helped a lot. Mayo Clinic, Dr Jonathan Morris

[GP24 in reply to Survivor1965]

Interesting post. I think yeatz does not want bone mets to be treated though.

Here are further details on treating bone mets with cryoablation:

newsnetwork.mayoclinic.org/...

[Survivor1965 in reply to GP24]

Yes, that was my guy

[adlerman in reply to GP24]

cryo-( freezing) has been around for at least 18 years- how could that possibly be considered "new"?

[dmt1121]

If you are speaking of biochemically recurrent PCa,my understanding is that it is by definition not curable, as it occurs after initial treatment (i.e. RP or some other form of primary treatment that has destroyed the primary tumor) after reaching your nadir for PSA (hopefully undetectable). The steady rise of your PSA level to .2 and higher over several months means that the primary treatment has failed and PCa has escaped the primary tumor site and is now systematic.

To me, all the follow-up treatments come down to trade offs between quality of life, effectiveness at achieving your personal treatment goals, how the sequencing of treatment modalities effects your future treatment options. (i.e. EBRT for the primary prostate cancer tumor may make salvage radiation or surgical solution infeasible-if the EBRT is done first) and what viable options you have left.

We all have opinions based on our own experiences but everyone's response to treatment will vary. As an example, you have major problems with side effects from Lupron and I do not have as many, so that may not make sense for you (depending on progression and efficacy) and would make more sense for me.

The ablation technique is very interesting but I am not sure how it applies to BCR because it is site-specific (used to treat individual tumors). I am guessing this is why your MO is proposing Lupron, also because it has stronger replacement treatments that fight a more resistant disease later.

ADTwill provide "suppressive fire" on testosterone while the PCa remains systematic (but undefined), hopefully slowing metastasis. If you treat individual tumors at this phase, you will likely not be able to find enough of them, if at any or you will be be playing "wack-a-mole". If the disease is aggressive, it will progress systematically while you are fighting individual tumor sites. My goal would be to slow down the progression of the overall disease and attack individual tumors as you can identify them through newer more-sensitive PET/CT scans. This fights on the macro and micro scale. Meanwhile, maybe an immuno-therapy treatment may come along to change the paradigm for good in our favor!

I hope you find the treatment plan that's best for you. Good luck!