Uro and Surgeon Recommending Focal Cryoablation

[rlafford]

After confirming my pc diagnosis via biopsy was accurate, I have been looking at various treatments. Based on location and size of my tumor, I am currently scheduled for focal therapy using cryoablation. Any thoughts pro or con would be appreciated.

E. Prostate, left mid, needle core biopsy:

- Prostatic adenocarcinoma, conventional/acinar type, involving two (2) of fragmented cores (see Comment).

- Gleason score: 3 + 3 = 6 (Grade Group 1).

- Tumor quantitation: Two (2) small foci, 5% of the total specimen.

G. Prostate, lesion #1 (right mid anterior transition zone), needle core biopsy:

- Prostatic adenocarcinoma, conventional/acinar type, involving four (4) of four (4) cores

(see Comment).

- Gleason score: 3 + 4 = 7 (Grade Group 2; less than 5% Gleason pattern 4).

- Tumor quantitation: 30% of the total specimen.

[Tall_Allen]

Why not just stay on AS?

[rlafford in reply to Tall_Allen]

A question I asked too. Rational for treatment was that the pc was localized, easy to get at and we might possibly be done with it now rather than wait for it to grow.

[Tall_Allen in reply to rlafford]

PCa is multifocal about 90% of the time. That means the cancer that you can detect with imaging/biopsy is not all there is. That doesn't mean that you have to be treated. It may never progress, and it would be a shame to experience any side effects of any treatment if you don't have to. The experience of many men in AS clinical trials is that, with diagnostic stats like yours, progression seldom occurs, and active surveillance will comfortably catch those few cases before it occurs.

But because of the multi-focal nature and cryo's limitations in destroying cancer cells, focal ablation is often not curative. In a whole-gland study of cryoablation, 37% had residual cancer in the ablated prostate. In a study of focal cryoablation, 23/50 (46%) of patients undergoing re-biopsy were positive for PCa. Baskin et al. reported that neither MRI or PSA were adequate indicators of progression. On biopsy, 10% of patients had residual GS≥7 cancer on the treated side, and 10% had GS≥7 cancer on the untreated side. (citations in the article below)

prostatecancer.news/2016/12...

The idea of aiding AS with focal ablation of various kinds has come up several times:

prostatecancer.news/2017/01...

AS proponents (including myself) argue - why help AS when it doesn't need help? You may also be interested in these efforts to extend time on AS:

prostatecancer.news/2022/06...

[rlafford in reply to Tall_Allen]

Your argument makes complete sense. 90% of my visits, even going over test results, have been with the urologist's assistant and she, from the day PCa was diagnosed, has focused on treatment, ie. consulting with radiation or surgical resources. Thanks for the articles!

[cesces]

Seems like a fringe treatment. Why do they think it is particularly appropriate here?

Get a second opinion from an sbrt radiation specialist.

[CarverD]

With less than 5% grade 4 I personally wouldn't let them touch me. You have a lot of time to do some research and see what options you have and which of them work for you. I am not surprised that the docs are pushing treatment as that is where the $$$ are. With a regular monitoring plan AS seems most appropriate based on the information you have provided. Have you had an MRI done? Was the biopsy guided or a TRUS? Have you consulted with other urologists?

[rlafford in reply to CarverD]

I did have a 3T Multiphase MRI done, which found the area targeted by the biopsy. I have not consulted with another urologist though.

[Piano777]

Look into NanoKnife IRE focal ablation. I had Gleason 7 (4+3) and had IRE ablation through a clinical trial. Outpatient procedure with zero incontinence and no ED afterwards. PSA down from 5.76 to 1.21 and clean MRI 6 months after procedure.

Nanoknife has been around for 10+ years for other tumors and is doing clinical trials to be approved to say it is for prostate tumors as well.

The main advantage over other methods (basically some form of heat or cold) is the ability to tightly control the cells impacted and they die a "natural death" based on nano holes in the cell membrane. HIFU and Cryotherapy are attempting to heat/cool the middle (prostate cancer) of a tea kettle full of water without heating/cooling the rest of the water (where the nerves are). IRE can actually do that.

clinicaltrials.gov/ct2/show...

Although it's a clinical trial, the technology has been around for 10+ years and used for pancreatic and liver tumors.

Excellent info on previous trial and incontinence and ED results: ncbi.nlm.nih.gov/pmc/articles/PMC8230282

These trials were across multiple levels and ages so there was some ED, but problems were correlated with lower erectile function pre-procedure.

[rlafford in reply to Piano777]

Thanks much for your recommendation. I found out that the surgeon who did my biopsy here in Rochester, NY is part of the clinical trial. I'll see if I can have a conversation with him regarding the trial and if I might be a candidate.

[Piano777 in reply to rlafford]

If you go to the clinical trial link you can see all the qualifications and disqualifiers. It's pretty straightforward to interpret.

FYI, All of the treatments and testing are done at no cost to you,

if you want more info, DM me ( if available here)