Mike from VT. recurrence after treatment

[MKhelix]

Hi Mike here, new to this site. I had Brachytherapy for prostate cancer in 2012 failed in 2014 Focal cryoblation (freezing) 02/2016. They found cancer returned on MRI 11/2017. Hoping to repeat cryoblation as new lesion was small and still contained in prostate. Just had a MRI guided biopsy which showed 3+4 =7 Gleason,Grade #2 with 20% of tissue. Perineural Invasion was found, waiting to consult with my doctor and worried about still going for a cure verses hormones which I am against taking. 62 good health otherwise and no signs of it having spread outside the prostate. Is perineural invasion a really bad sign for longterm outcome? Thank you for any advice.

[Tall_Allen]

Perineural invasion (PNI) is certainly a risk factor for spread, but it is not in itself evidence that spread has occurred. It is just one of several routes out of the prostate that the cancer can take.

Brachytherapy (seeds) can be tricky -- seeds shift, and there may be hot spots near the seeds and cold spots farther away. Cryo, as you've learned, can be problematic because of incomplete ablation in the ablation zone. Also, with repeated treatment, there is a possibility of damage to erectile function and urinary damage. There are other alternatives: salvage focal high dose rate brachytherapy delivers a much stronger radiation dose only to the place where you need it; salvage seeds can be placed precisely at the site of recurrence; and salvage whole gland SBRT can give assurance that any microscopic amounts of cancer elsewhere are killed off too. You have to find specialists who do these therapies, and you may have to travel for treatment. Below is an article that discusses some possibilities.

pcnrv.blogspot.com/2017/09/...

[MKhelix in reply to Tall_Allen]

Thanks just read the article and it will be helpful when discussing options.