Good cryo or HIFU salvage doctor names in California.

[wilcoxsaw]

Anyone have the names of a good doctor in California doing salvage cryo or HIFU on a previously radiated prostate. I believe Duke Bahn has retired or will be doing so soon so don't include him.

[Tall_Allen]

I don't know how good he is, but Kia Michel at Cedars does HIFU. Also at Cedars, Mitchell Kamrava does focal salvage HDR brachy. In San Diego, Don Fuller does salvage SBRT. My Uro, Leonard Marks does focal cryo at UCLA - I'd think he could do salvage focal. John Feller does focal laser ablation in Palm Springs.

The big issues with focal salvage thermal ablation are that 80% of the tumor is not seen on the MRI, heat sink effects may render the ablation non-lethal, and the cancer has protective mechanisms (e.g., heat shock proteins) that may protect it from ablation.

[Hidden in reply to Tall_Allen]

I disagree. Unless they were lying to me about the equipment they can monitor the temperature reached by each small blip being zapped. They can monitor position in real time. I recommend full gland as opposed to focal ablation. More thorough. Might need TURP surgery prior to full gland ablation. There are limits on the size of the prostate that can be treated by HIFU related to how deep it can reach or focus. ADT shrank my prostate prior to the surgery.

[Tall_Allen in reply to Hidden]

In a recent study, a quarter of the men who were treated with full gland Tulso Pro had a rcurrence within 5 years. They may have tried to get the temperature of some tissue to a certain level, but apparently it wasn't sustained long enough because of the heat sink effect. The tissue that was supposed to be destroyed wasn't.

[wilcoxsaw in reply to Tall_Allen]

So, do the studies show focal cryo or HIFU to be more effective? One of my concerns is the possibility of urethral/other damage occurring after cryo. An individual I recommended go to Duke Bahn instead used a doctor at U of Oregon for focal cryo following proton radiation. His life became one of misery for 2 years after they destroyed his urethra. He ended up losing his bladder, urinary system, and has a permanent bag.

So far, my search has turned up 2 names, Marks at UCLA, and Abreu at USC that heads up their focal therapies program as ones I'd consider.

[Hidden in reply to wilcoxsaw]

Cryo is a blunt instrument. HIFU is a precision instrument with realtime feedback as to position and temperature reached. I wonder why TA doesn't condemn Cryo like he does HIFU.

[Tall_Allen in reply to wilcoxsaw]

I just gave you a list of names. For some typical results, see the table at the end of the following article:

prostatecancer.news/2017/09...

For toxicity, it depends where the cancer is that you're treating.

[wilcoxsaw in reply to Tall_Allen]

Thanks

[Hidden in reply to Tall_Allen]

Tulsa Pro isn't HIFU.

[Tall_Allen in reply to Hidden]

Yes it is. It stands for Transurethral ULtraSound Ablation of the Prostate. It is just MRI-guided.

[Hidden in reply to Tall_Allen]

MRI guided without temperature feedback. Not the same.

[Tall_Allen in reply to Hidden]

Thermal ablation is thermal ablation - 25% recurrence after 5 years on whole gland - just not very good.

[Hidden]

Michael J Lazar of Santa Rosa was my HIFU surgeon. Operations are performed at an outpatient clinic in San Franscisco. On Sutter Street if memory serves. I was directed towards radiation by my AZ urologist but skipped that and went straight to HIFU, having to go out of state and out of pocket.