My plan is to have salvage brachytherapy or cryotherapy. The thing is these treatments will take time to be scheduled, especially brachytherapy as this would be with Dr Zelefsky in New York and I don’t have an interview with him until Nov 19. I meet with my urologist on Oct 29 to go over the recent biopsy and I hope we discuss cryotherapy but he may want to schedule that for another visit. My guess is it’ll be December of January if I decide to do cryotherapy with him. Same for Zelefsky or even longer. So that means 2-3 more months for an opportunity to spread.
I’m kinda freaking out. Some articles say with negative PSMA, Gleason 4+3 with PNI there is not a sense of urgency; other say ADT should be started immediately. I believe I've read somewhere that starting ADT before salvage might cause tumor shrinkage and the make MRI guidance less effective in the placement of seeds.
I know this is ultimately a question for the docs, but I’d like your opinions
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hwrjr
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I have had this disease so long I had to Google a number of terms in your bio. So, your PSA has unfortunately jumped over the 4.0 ceiling. Normal SOC at this point would be ADT, possibly Lupron and casodex. Don’t freak out. Your PSA is still very low. It’s great your PET showed no mets. If the cancer is still encapsulated, I am surprised a prostatectomy was not suggested. Please read my bio. Try to keep a positive attitude. With all the shit that’s gone my way, I attempt to remain positive. Where you are now, 2-3 months should not be much of an impact. WRT additional treatments, cryo would be more direct. Brachy will work, but will come with more S/E. I was first placed on ADT. Three months later, brachy, 60 days later IMRT. I would also suggest finding a local support group. Best of luck let us know how things go.
"It’s great your PET showed no mets. If the cancer is still encapsulated..."
Regarding encapsulation, hwrjr said he had PNI (perineural invasion), which means cancer cells were seen surrounding or tracking along a nerve fiber within the prostate. This means that there is a higher chance that the cancer will or has spread outside the prostate but is not detectable yet. I would w ant to start ADT as soon as possible.
I had radiation therapy to prostate (in lieu of prostatectomy) about four years before ADT, because there was no sign of metastases. I would think your case is similar to mine.
p.s. Lycopenes cause tumor shrinkage. Lycopenes can be consumed during the time you are between doctors. Read my bio.
Just a FYI, 2015 GL10 right half I had CRYO --- my Dr. does a TRIPLE FREEZE with PASSIVE THAW between. If you do go with cryo, make sure it is the triple freeze protocol and not the double.
I met with Dr Polascik at Duke yesterday to discuss my recent biopsy results and to discuss possible salvage cryotherapy. As I already knew, I have Gleason 4+3 with PNI and a finding of ASAP in one of the systematic biopsies. Dr Polascik didn't think the PNI and the ASAP were of any consequence.
He said he thought I was a good candidate for focal ablation but he would do the whole gland if I preferred. Unless I learn something in the next few weeks to change my mind, I will go with focal as it has similar efficacy but fewer side effects.
I wish I had asked him about an injection of vitamin D a day or two before the procedure. Studies show this enhances the cryotherapy's ability to kill. Also, I wish I had discussed his application approach. Will he freeze in a quadrant to broaden the margin to 1 cm around the target?
He does a double freeze and thaw. Here's what I found when I googled double vs triple: "When treating prostate cancer with cryotherapy, a "double freeze-thaw" cycle, meaning two cycles of freezing and thawing the cancerous tissue, is generally considered the standard practice and is more effective than a "triple freeze-thaw" cycle, as the additional freeze-thaw cycle in the triple approach may not significantly increase cancer cell destruction while potentially causing more tissue damage and complications; most studies and clinical practice support using only two freeze-thaw cycles for optimal results."
He did not think starting hormone therapy now was necessary even if the procedure is 6-8 weeks away. He said it wouldn't affect the procedure in any way if I wanted to take it while waiting if taking it made me feel better.
He agreed to try to get me scheduled ASAP. He does Cryo on Tuesdays and there are always cancellations because patients fail the anesthesia review and have to have additional tests to qualify.
I still plan to see Dr Zelefsky in 3 weeks to see what he has to say.
My Dr. as been using cryo 40+ years AND was a pioneer in its use for PCa plus the introduction of Focal.
TRIPLE Freeze requires greater application skills because of the increased risks of damage and thus is not SOC.
In 2015 I had his Brachy Grid Guided Transperineal 3-Dimensional Prostate MAPPING Biopsy resulting in 100+ core samples that covered 90+% of my prostate for biopsy. This procedure is time intensive but allows for locating the edges (margins) of the tumor that in turn can provide the superior location for treatment.
My Gleason 5+5 (10) tumor was shown to be totally enclosed in the RIGHT HALF and he used enough freezing needles to ablate THE WHOLE prostate. By using excessive needles he had better control of the freeze ball and could freeze slowly making sure not to expand the ball too far from the tumor while holding the freeze longer assuring the triple freeze time frame with the passive thawing that also allows the longer time of cold for cellular kill.
Longer time for the freeze under GENERAL ANESTHESIA for his protocol was a concern but knowing that he had been performing PCa Cryo as long or longer than other's helped calm my nerves.
p.s. - he pioneered a PCa Immunotherapy that he used on his own PCa in 2019.
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