Tulsa-Pro any thoughts? Newly diagnosed Gleason 7 (4+3), T1c, PSA 4.92

[USAFproudmom]

Investigating all options. Talked to Rad Onc and Urologist is referring us to Dr. Vipul Patel in Celebration, Fl. We live about 1-1/2 hours away from there. Just really torn about which route to go? Have had some major surgeries and have had some issues with blood pressure while being put under anesthesia so that scares us a bit. But want to get rid of the cancer as well.

[Tall_Allen]

What is your diagnosis?

Tulsa-Pro doesn't work much of the time:

prostatecancer.news/2021/03...

[Hidden]

I know quite a few that tried it with (4+3) GG3 and it didn't work permanently, to my knowledge, for any of them.

[Yearofthecow]

If you are concerned about the anesthesia, TULSA PRO requires general anesthesia, with intubation, and will require a catheter after the procedure, for a couple of weeks.

TULSA PRO is still a very new protocol.

Are they recommending doing the whole gland or just the area of concern?

When TULSA PRO was presented to me as an option, I had two areas of concern. One in the TZ, and a very small are in the PZ. They only wanted to do the one in the TZ, and just monitor the one in the PZ. They were both 3+4, with 10% pattern 4 in the TZ . The PZ was too small to estimate a pattern 4.

The reason they told me they didn’t want to do the small one in the PZ at that time was because they believed there would be more side-effects if both areas were treated, and the PZ could just be monitored with Active Surveillance at this time.

In the end I decided on SBRT utilizing the ViewRay machine, because I wanted to have the whole gland treated once and for all, and didn’t want to go through general anesthesia.

Regardless what you decide, I think it would be prudent to request a PSMA before starting any procedure.

Wishing you all the best

[Bethpage]

Dr. Patel did a simple on my husband in 2014 (age 71) and a salvage in 2017 (age 74). Both the simple and the salvage were ill-advised. My husband had a PSA of 14, rising from 2003 and with 11 years of negative biopsies. Patel failed to do an MRI guided at the PSA of 14, went ahead with the simple, which naturally failed. My husband was his patient from 2014 to 2019 and is Patel's largest patient file. BUT, he is undoubtedly one of the finest robotic surgeons anywhere. If you go that direction, my *sincere* advice would be to move on to another specialist after prostatectomy + the first PSA. Wishing you well.

PS I'm willing to elaborate on the advice in a chat if you'd like.