I just updated this article with new evidence that:
(1) mpMRI misses 30% of the significant cancer outside of the index lesion
(2) 77% of FLA-treated men at NYU had a positive biopsy in the ablation zone 2 years after treatment. Neither mpMRI nor PSA were useful predictors of biopsy outcomes.
I now agree that my chryo focal treatment was probably a mistake even tho my mri showed no cancer in the prostate. I will be showing your article to Sholz at my next appointment. Question tho. When my C-11 acetate scan by Almeida, (2 years ago and 7 years after my focal chryo) showed three bone mets, but no cancer in the prostate (along with my Margolis read MRI showing no residual cancer in the prostate) , do you think there’s still a good chance there was residual cancer in my prostate. Or that it had simply escaped the prostate before the chryo? And do you think any treatment to the prostate itself may be worth considering , even tho I’ve been .02 for over a year?
Thanks TA.
Schwah
It's a good question, and I don't have an easy answer. I don't know how well a negative C-11 acetate PET scan does at predicting living cancer in the prostate after cryoablation. They would have to do a trial where they biopsy the prostates of men who had a negative PET scan and cryo. I don't recall seeing such a trial. One of the points Chao makes is that ablation makes scans very hard to read, even by experts. Biopsies are difficult to interpret after ablation too. Chao opines that the decision to biopsy based on a negative mpMRI should depend on whether the patient wants to salvage treat the prostate even if the residual cancer is GS 6. However, even if GS 6's only progress for 1-2% of men per year, that adds up over the next 20 years.
Hi Tall Allen,
I read that article from NYU and that article and the response from the FLA doctor convinces me to abandon that approach. I am now considering HIFU. You appear to be very pro SBRT and that was your treatment. I read your sections on HIFU but I don't see numbers to compare it with RT or RP. So how much worse are the numbers?
The same issues apply to focal ablation with HIFU. Low/intermediate risk men getting SBRT have a 5 year biochemical recurrence rate of 3%, compared to 28% for HIFU.
Well, I told this to a friend of mine and they sent me this: medpagetoday.com/hematology...
Which shows 12% recurrence within 5 years.
I referenced their study several times in that article. First, where I wrote, " Cancer was found in the ablation zone in 36% of the patients who had biopsies for cause in this study."
The 12% recurrence rate doesn't include those who were re-treated with HIFU multiple times. You can see in Table 3 of the Ahmed/Emberton HIFU study, 25% of all patients were treated multiple times with HIFU and an additional 8% had radical therapy or hormone therapy .
Thanks for posting this.
My mpMRI missed 50% - it show two lesions, a 6,3+3 & a 7,3+4. in actuality the biopsy found 2 of each lesion for a ttl of 4
Yeah, mpMRIs have a high detection rate for higher grade and larger tumors, but are worse than a systematic TRUS biopsy at finding smaller, lower grade cancers.
Salvage focal HD brachytherapy 
No BT for those with Urinary Issues?
53 yrs old, 3+4 Treatment Choice
Urologist recommendation at Johns Hopkins
