Total Gland Ablation Experiences w' TULSA-PRO?

[PaulG1449]

Greetings All, I'm seeking feedback on others' experiences w' PC who had total gland ablation via TULSA-PRO. Cured? ED? Incontinence? Complications? Other?

My PC is anterior bilateral Gleason 4+3 & right-base 3+4. Had consults w' two TULSA east coast experts & both recommend total gland ablation. A few cases in the forums I read where the ablated prostate tissue, weeks after the ablation, folded in on the urethra resulting in blockages & ER trips; one dr said this only happens if the prostate is very large (i.e.100cc). My prostate is 72cc. Thanks in advance!

[Tall_Allen]

You may want to read this first:

prostatecancer.news/2021/03...

[PaulG1449 in reply to Tall_Allen]

Thank you Tall_Allen. Pretty gloomy results. I can't help but wonder at the experience level of the doctors that used TP in this study. The doctors I'm considering have each done hundreds of TP ablation procedures.

[Tall_Allen in reply to PaulG1449]

Here's the important lesson learned: Even though the average prostate size was reduced from 40 cc to a burned out husk of just 2.8 cc, 35% of the men still had cancer in their prostates a year later. HIFU does not kill all the cancer. That's why the FDA refuses to approve it as a cure for prostate cancer. It is only approved for the ablation of prostate tissue (like a TURP).

[PaulG1449 in reply to Tall_Allen]

You come across as quite anti Tulsa-Pro, “burned out husk?” I’ve consulted with three different radiation doctors and all of them state the entire gland is killed with radiation, just a different way of creating the “burned out husk.” So, were you treated with Tulsa and had a bad experience? Or do you know someone who had a bad experience? Because you do seem quite biased against it.

[Tall_Allen in reply to PaulG1449]

I'm only repeating the data that Lawrence Klotz published:

auajournals.org/doi/10.1097...

I am only "anti-Tulsa Pro" because over ⅓ of men having whole gland ablation still have cancer a year later - that's what he reported, not me.

Ignore the experience of 115 men at your own risk. You asked- don't shoot the messenger.

"all of them state the entire gland is killed with radiation just a different way of creating the “burned out husk.” Radiation kills only the cancer within the prostate, not the entire prostate. My prostate now (15 years after SBRT) is about 25 cc and no BPH - I pee like a racehorse and have a fully functioning prostate. Not a burnt-out husk at all.

Radiation works totally differently from thermal ablation. It inserts hydroxyl radicals in the prostate DNA. Cancer cells cannot repair the DNA damage, so when they attempt to replicate, they self-destruct (called "mitotic catastrophe"). That's why it can take years for PSA to reach nadir. Healthy cells can repair the damage, or if they can't they destroy themselves (called "apoptosis") and are quickly replaced.

[drzaius in reply to PaulG1449]

I don't know what doctors told you that whole gland radiation kills all cells but I would be looking for another doctor. You will still have a prostate after radiation, since cancer cells die but healthy cells can recover. That's why one's PSA doesn't really drop as low as with a RP and can actually bounce around some the first few years. I opted for radiation because of the current accuracy improvements in the last 15 years. I also felt leery that HIFU method could monitor the thermal energy consistency across the prostate since it comes from a central source out to the surrounding prostate. I had a Gleason 6 by the way. Good luck on your decision, It's not easy.

[fast_eddie in reply to drzaius]

I had HIFU surgery. The equipment provides realtime feedback on both position within the prostate and the temperature each tiny ablated tissue blip reaches.

[Xavier10]

Didn't work for me or 4 other guys I know that tried it for a 4+3. I know a 4+3 that did it and the PSA has crept up and he is going to go back at it again this time with HIFU, since the Dr. that did us doesn't do Tulsa anymore. Also, the instrument didn't work right for him, and his took twice as long because they had to switch it out. Another 4+3 it didn't work and turned into 4+4 on a much smaller prostate somehow and he tried FLA after it and still has a rather high PSA. There's a couple others I know also. My general impression is it is more for people that seem to have an aversion to any kind of radiation or surgery either. These examples I am giving are from 2020 and 2021. Maybe the technique has improved. I guess it could work if you stay after it ever few years or so but that costs a lot of money and it just seems like it might get out sometime. Seems like a one and done radiation would be better. Certainly has for me. Wish I had my $30,000 back. The other thing is after I did it I got a scan and the urologist said it looked like I had a 26 cc prostate. Supposedly the prostate is supposed to be ablated down to about 3 or 4 ccs. Maybe the instrument didn't work on me. When I finally did IMRT the urologist was going to put in a space oar but he said the Tulsa Pro had nixed that when he got in there. Not exactly sure why. But Tall Allen doesn't care for space oars and my RO just extended my sessions with a lower dose instead so maybe that was good after all. Finally, Profound Medical tries hard and probably has improved the technique but I haven't noticed the stock price getting past around 7 for years. I think the technique may have some uses but probably not for 4+3 or worse.

[Mgtd in reply to Xavier10]

Boy that is a steep hit for something that did not work. Just curious what made you choose that over radiation?

[Xavier10 in reply to Mgtd]

good question. I honestly can't remember but everybody was looking for an alternative to surgery and radiation a few years ago and the Inspire site I was reading at the time had a poster that was heavily advocating it. Sales, in other words

[Flapr]

I had laser ablation in 2018 and got an infection that send be 4 days to the hospital and over 30 days of antibiotics injected. The cancer returned a few years. I got adaptive sbrt with 5 sessions with no side effects (only 2 weeks of lite pain urinating ). Covered by medicare

[fast_eddie]

I had successful HIFU full gland ablation 8 years ago for Gleason 8, one side cancerous. My prostate volume was about 33 cc at the time. I think your prostate is too large for HIFU treatment; there is a limit as to how far it can focus out to ablate tissue. I also had TURP surgery 10 years prior. That is almost a prerequisite for full gland HIFU.