TULSA

[peterman]

I have been on active surveillance for 3 years. My most recent biopsy showed that my prostate cancer is getting more aggressive and now it's time to do something. When I was first diagnosed I looked into all the available treatments and decided that RP was the way to go for me. Since that time new treatments have come out. My doctor/surgeon has suggested I look into/consider TULSA. ( profoundmedical.com/new-tulsa/ ) Has anyone had heard of this treatment, know anything about it, have any experience with it? It is in trials and has only been used in a limited (115) number of men. It seems promising (not as invasive, lesser side affects, etc.) but I am unsure because it is so new.

[SmasherOfAjumma]

So you said, "I looked into all the available treatments and decided that RP was the way to go for me". Did you get a Radical Prostatectomy? I thought active surveillance and radical prostatectomy were mutually exclusive.

[peterman in reply to SmasherOfAjumma]

I have been under active surveillance up until now. Given my recent [not good] biopsy I now have to pick a treatment. I have not had an RP yet.

[maley2711 in reply to peterman]

Over at Inspire, VirginiaNorthern is a big advocate for TULSA PRO.....he had the procedure as part of a trial at Hopkins.....Hopkins seems to be very optimistic about the protocol . No randomized studies comparing TULSA to radiation or surgery.....but there is this, which includes the similar HIFU option................

healthunlocked.com/api/redi...

Also, Allen has previously posted this treatment comparison summary....

healthunlocked.com/api/redi...

Allen notes that there are no definitive random trials , so we are left with comparisons of data for different treatments in which important vaiables are not randomized among treatment populations. Still, if numbers are large enuf, and means of variables are similar for different treatment groups, this type of comparison may lead to a usable conclusion.

Best of luck in making a good decision for your particular circumstances/priorities. NOT easy for most men! Warren Buffett chose radiation at age 80 I believe....he's a smart guy, so............?

I believe it is proposed that TULSA PRO still allows for later surgery or radiation..but not sure about salvage surgery? There are a few Docs who will do salvage surgery afer radiation......but very few will do......too difficult because of tissue damage from radiation.

Not sure about using ablative procedures for salvage treatment after radiation?

I will probably soon be in your position BTW! I've made itto age 72 with a marginally high and slowly increasing PSA since age 64.....but my terrifyingly high MRI PIRADS grade does not bode well for me. Difficult to pull the trigger on any of these treatments, with almost certain immediate reduction in QOL, when a man is feeling fine and no guarantee the cancer would ever progress to a life-threatening situation.....as oppose to something like pancreatic cancer!

Interesting aside....I just recently mentioned to my uro that he had probably deduced that I have needle pobia...he immediately replied thata he is in the same club.....mentioned dentists!! Remind me of Doc Martin and blood. Great show!!

aren't w all so lucky to have the internet and all the access to info and help that those before us were without!!

[peterman in reply to maley2711]

Thanks Maley2711.

Who did you say had the TULSA treatment? I would love to connect with someone who has had it to hear about their experience.

I agree that Warren Buffet is a smart guy but I'm only 58 years old. If I was 80 my treatment decision would likely be very different.

[maley2711 in reply to peterman]

Sure, hook up with VirginiaNorthern over at Inspire.com...his was done at Hopkins several years ago I believe. Several men on Inspire have had that treatment. There are critics of TULSA PRO whole gland who think TULSA should be primarily used a an excellent focal therapy option. What is really needed, but a long time coming, is 10 yr results, IMHO. Someone on Inspire just posted European paper of 5 yr HIFU results for 625 men. Results were incredibly good. I must say, thinking about this, with these focal treatments, salvage radiation, or surgery, can be used later if recurrence after focal. With radiation, salvage treatments are questionable....usually on to dreaded ADT!!! But, some radiation treatments have very good 10 yr results! Possibly/probably better than 10 yr for surgery?

[Tall_Allen]

You are right to be skeptical. You may want to read this before diving into any focal ablative therapy:

prostatecancer.news/2016/12...

In a recent study of whole gland TULSA-PRO, a third of the treated men had local recurrences:

auajournals.org/doi/10.1097...

Much more curative and lower rates of expected side effects can be obtained with SBRT or HDR brachytherapy monotherapy.

[peterman in reply to Tall_Allen]

Thank you for the articles Tall_Allen.

[mlbky]

Here is a link to PCRI's (Prostate Cancer Research Institute) recent webinar of a non biased interview with Dr. Laurence Klotz that discusses the TULSA Pro procedure, its pros and cons.

youtube.com/watch?v=ViAJTw4...(Not working as expected?)

[peterman in reply to mlbky]

Thanks mlbky. This is a very informative video.

[aceace12]

how many biopsys have you had since starting AS ?

[peterman in reply to aceace12]

3. I had an initial one when I was diagnosed then two more since then. I've also had 2 MRIs. The last biopsy, in early October, is the one that came back showing more aggressive.

[aceace12 in reply to peterman]

k good luck.... i have been on AS 2 years had 2 biopsy 1 MRI,, first biopsy 3 cores gleason 6 ,

....last biopsy came back benign on all cores .... im not sure what next except i know PSA every 3 months

[leach234]

At 58 just have the surgery and get it over with. If you spent as much time researching surgeons as you do other options I’m sure you would have picked a very experienced surgeon by now!

[peterman in reply to leach234]

I have been working with a surgeon who has done many RPs. He is the one that [ironically] mentioned the TULSA ablation to me.

[Hidden]

You may want to consider HIFU. With TULSA being a very new treatment option you won't find practitioners with much experience with it. Either way, get full gland, not focal, ablation for a more thorough job attacking the cancer.

[SPEEDYX]

!!!LIVING!!!on Tulsa Time.....Don Williams......Eric Clapton.

[Union98]

If anyone is in the Atlanta GA area and are interested in this procedure, you may want to sign up for the webinar given by Dr. Busch. Dr. Busch (when he was in Chattanooga) was very helpful when my husband was first diagnosed. He did all Keith's imaging until he moved his practice. He's very passionate about new treatment options for Prostate Cancer. and works relentlessly for his patients. We really miss him. buschcenter.com/tulsa-proce...