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cryosurgery

joe20171
Posts: 1
Joined: Aug 2009

Just recently was positive for prostate cancer: PSA 9. Gleason 3+3=6, one positve sample of 12 taken. DRE negative.

I have read the discussions about the various procedures and experiences available on this site but have not seen anyone mention cryosurgery. Does anyone have any experience with this procedure and any thought about it? Am meeting with someone about it in a couple of weeks. Any experiences known about this personally or from others.

Thanks

lewvino's picture
lewvino
Posts: 1004
Joined: May 2009

Joe,
How old are You?

When my Doc told me what Cryosurgery is and how it works I immediately ruled it out for me.
With Cryo they place a tube up into the prostate and then fill it with a super cold gas. This then freezes the prostate and the cancer cells. Maybe the process has improved in time but I've read that in the past they had problems controlling what and how far the freezing would go. So It could freeze urinary tract, the erectile nerves and in some cases clear out to the actual bowel or bladder.
Take a look at http://www.upmccancercenters.com/cancer/prostate/cryosurgery.html

in particular read about the side effects and disadvantages.

It appears your cancer has been caught early. Good luck on your consult. Remember you have to choose what is right for you and don't let a Doctor push you towards a particular 'cure' They all have the same goal....Getting rid of the cancer.

Larry

shubbysr's picture
shubbysr
Posts: 87
Joined: Jun 2009

Hey Joe,

I totally agree with Larry. I was told that cyro is done on "older" patients. Meaning that they do not need erectile function and are use to dribbling!
You did catch it early with 1 of 12 core samples being positive.
Good luck with your decision.

Jim (shubbysr)

muttsrule
Posts: 52
Joined: Sep 2009

All my reading leads me to consider cryosurgery as a first effort. I'm PSA 4.2, localized T2A staging, Gleason 3+3--and no concern about ED. But I read here that nobody thinks much of it. I hope to hear from guys who have had the procedure. Thanks. John

nymets1
Posts: 26
Joined: Sep 2009

This is my first post on this board (I have been visiting it for awhile but felt compelled to make a reply here):

Cryoablation of the prostate IS a viable primary option as well as the preferered salvage option for failed radiotherapy. Unfortunetly, cryosurgery gets little fanfare or respect.

I had cryosurgery in 2006 and while I am on the way toward failure, I am not disapointed nor surprised because my cancer was already aggressive (GS 4+3, psa 12.4) and even though my psa has risen a bit since nadir, I still have time to decide other options, including a second salvage cryo, if warranted. I am not an old man (presently 57) and when it was highly recommended that surgery would be the least effective method of possible cure with my GS, I easily chose cryo ahead of radiation, particularly since my surgeon was one of the best in the country (Dr Ralph Miller- Allegheny General).

I have NO incontinence (continence went from a few drips during the first 6 months to 100% continent afterwards)and yes I am impotent but Viagra does help a lot. And I did not need to take Lupron either before or after.

lewvino's picture
lewvino
Posts: 1004
Joined: May 2009

Glad to read that you are making progress and recovering. I read about the cyroblation and think you are one of the first that I had read chosing that method. I hope you have many more years of success.

Larry

nymets1
Posts: 26
Joined: Sep 2009

Larry,
Thanks for the positive words. However, I cannot really call it a success. I rather call it a reprieve.

My nadir was 0.2 (Aug 2006),which was well below the 0.5 nadir that most cryosurgeons look at as being an initial success. Since that time my psa has steadilly risen to 0.7 (both in April 2009 and July 2009). My cryosurgeon uses a psa of nadir +2 as the standard for failure (or 2.2 psa in my case). While I am still quite a bit away from that number, we have agreed to do a biopsy and other testing when my psa hits 1.1 or 1.2 and not wait until it hits 2.2. I am taking a number of supplements in efforts to keep the psa from rising. I credit pomegranite extract and green tea for helping to keep my psa at 0.7 during the last 3 month test (it had risen 0.2 during the prior six months). I have added fish oil recently and will in a few months start on one of the diets recommended by cancer experts. I will do anything possible to hold off hormone ablation. However, it will be either some salvage treatment (cryo or radiation) if they find cancer in or near the prostate or hormone ablation if they don't (or see actual metastasis0, which at this stage is unlikely.

BTW: The reason why there is usually some psa after cryo is because there is always the possibility that a small amount of prostate tissue wasn't killed. The lower the psa,the better. Post cryo,the surgeon does a biopsy to see if any cancer is still evident. In such cases, an immediate failure is declared and the patient is urged to do another freezing.

The UPMC article is aged (even though it says it was updated in 2009). Recent cryoablation techniques make cryo probably the safest therapy offered; only impotence is a given and third generation cryo offers nerve sparing surgeries to those who would qualify.

For those with very limited PCa (GS 6 or less; Psa < 10), the gold standard is still surgery. But for those who would benefit more from radiation than surgery, cryo should definetly be considered.

lewvino's picture
lewvino
Posts: 1004
Joined: May 2009

I find it interesting that the different treatments for prostate cancer seem to have different standards on the PSA. I know with surgery it is .2 and it seems from what I've read that for radiation they like .5 and you mention with the cyro its 2.2!

I believe there is a forum on the web called ice balls or something along that line for men that go with the cyro approach. Thought I would mention it in case you haven't heard of it.

I turn 55 next week and had robotic surgery 28 days ago.

Larry

nymets1
Posts: 26
Joined: Sep 2009

Hi Larry,

The existance of a psa in cryo (very few have "zero's") is due to the liklihood that some (hopefully very small) amount of prostate tissue wasn't totally killed. The purpose of the follow-up biopsy, done about two months aftrer cryo, is twofold: To assess the kill and to make sure no PCca is still there. If any cancer cells are found on biopsy, the treatment is immediately declared a failure.

The psa standard for "failure" differs among surgeons. I believe Cohen/Miller have done the most cryosurgeries in the world and their database goes back nearly 20 years. However, even with that, I agree that nadir +2 is a rather high psa failure threshold.

lewvino's picture
lewvino
Posts: 1004
Joined: May 2009

Thanks for your feedback. I missquoted and the PSA point for surgery is actually < .1
When my Local Urologist went over all the options for treatment he mentioned Cryosurgery but didn't say much about it. From what I read and I'm sure things have changed that they have problems controlling how much gets frozen. Do they still have those issues? It seemed like it could freeze out to the sexual nerves and urinary tract causing problems. Curious on what your age is and if there were other factors that helped you decide on Cryo.

Thanks,
Larry

muttsrule
Posts: 52
Joined: Sep 2009

Had mine frozen to death late last September, and check back in here from time to time to see if anybody has questions about cryotherapy I might help with. Nobody--it seems to be a rare choice. Random thoughts: 1. incontinence and whatever one calls urinary constipation: 5 weeks on the catheter, after which I dribbled erratically for a couple of weeks. Used a total of about 10 Depends pads during that time. 2. ED: nothing there, but I don't care. 3. PSA: am now 0.0. 4. "the kill": my urologist says a minimal amount of prostate must remain in this procedure in order to avoid the risk of freezing urinary function along with the devil. He said there's no reason to expect another biopsy unless the PSA starts rising. 5: recuperation: mine was easy, though it took longer than I thought--mainly because of the catheter weeks. Minimal need for pain pills (1 oxycodone + icebag in crotch + warm dog (rescue mutt) + good music + 1 hour a day for, say, 10 days out of 14 = actually enjoyable. 6: me and my numbers: I'm 68 and my cancer was early, small, and well contained. I can't remember my numbers, but if you search this site for 'cryo' you can find my comments from August-September 2009. 7. So I obviously recommend cryo as a good option for somebody in my particular situation. 8. Should be 1: my best wishes and prayers for you all. John in Seattle.

macguy's picture
macguy
Posts: 18
Joined: Nov 2009

This path started in July of '09, gathering info along the way. I am 74 in good health, 6'1" and 210 lbs. My final decision was for cryosurgery in May '10. The Bisacodyl and Trilyte cleared out my system like never before. I checked in at Beaumont Hospital (Royal Oak , MI) at 6 a.m. Off to surgery at 7:45 Woke up in recovery around 1 p.m. assigned a room for the night. No pain, Foley catheter and bag attached in urethra for drainage. Had dinner and a good night sleep. After a large breakfast was discharged by 11 a.m. and will have the Foley catheter and bag for 5 days. Medications: Doc-Q-Lace 100 mg, (stool softener) Celebrex 200 mg, (pain) Levaquin 500 mg (infection). Good to have the catheter out but the swelling made it difficult to urinate. Needed a diaper for safety the next a.m. and used it . Later that day went out to dinner sans diaper no problem. My scrotum looked like a large ripe grapefruit with a nose and my waist increased by 6 inches. Standing up and using a large measuring cup the hospital furnished made urinating much neater and comfortable. 14 days later the swelling and bruising in the rectum and penis has faded to a comfortable level. August will my first PSA check. Overall I am satisfied that I made the right choice for me. Time will tell. I'll be back in Aug for an update.
PSA July 06....4.16
PSA Nov. 07...4.08
PSA Nov. 08...6.18
PSA July 09,...6.89
Biopsy at St Joseph Hospital Sept. 8
Out of 12 biopsy cores 3 were positive
1 was 10%,
1 was 20%
1 was 40%.
Stage is T1c
Prostate volume 52 cc
Bone Scan: neg.
CT Scan : neg.
3 month shot of Lupron to reduce the size of the prostate
Dec 16 the hot flashes started (mild)
March 5 PSA dropped to .07
4 month shot of Lupron
March 26 Cystoscopy (all clear)

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Mac, great personal perspective and I hope cyro works for you. I have a couple of questions if you don't mind:

Did they freeze the entire prostate or did they focus on a specific area where they felt the cancer was present? I have read that both these techniques are used.

What have your doctors told you to expect with respect to urinary problems or ED?

And finally, with your PSA level reduced to 0.7 after Lupron, did you consider going into an active surveillance regimen?

Again, best of luck.

macguy's picture
macguy
Posts: 18
Joined: Nov 2009

The cancer was found in both lobes so the entire prostate was frozen. Doctor told me there should be no urinary problems and after the first day I have been dribble free. I may have to visit HOOTERS to check out the ED but I expect their hot wings will be the only excitement I'll find. The doctor explained that the lupron would kill 99 percent of the cancer and more importantly reduce the size of my prostate. He felt that the cancer was contained in the prostate but not to rely on lupron for a long term cure. We know that there are no guarantees with eliminating this problem. So we just take our best shot.

Thanks for your interest

macguy's picture
macguy
Posts: 18
Joined: Nov 2009

Got the good news today . . . zero PSA is such a nice nothing number. Go back in three months for another PSA check.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Great news, Mac. Very happy for you. How are the side effects, any issues?

macguy's picture
macguy
Posts: 18
Joined: Nov 2009

Controlling the start the start and stop of the flow is a minor problem but the doctor said that will disappear soon. Other than that I am 99% back. Just came back from a two week camping trip in our RV with my wife and granddaughter with no problems. Thanks for your interest.

macguy's picture
macguy
Posts: 18
Joined: Nov 2009

Latest PSA is .003 and that makes the Dr. and me very happy. I moved some furniture last August and started leaking. That resulted in 2 pads a day until Dec. when it stopped. Dr. said that is not unusual . . . so my sons are our new furniture movers. I go back in May for another check.

macguy's picture
macguy
Posts: 18
Joined: Nov 2009

PSA is still .003 next check will be in 6 months. Life is good!

VascodaGama's picture
VascodaGama
Posts: 1517
Joined: Nov 2010

Mac
This is a great outcome from your treatment anniversary. That number signals complete remission.
Hope you keep reporting on those Zeros and experience.
The best to you
VG

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

I am wondering what led to the Cryosurgery decision as a result of your Gleason of 4+3 =7 and a PSA of 12.4? Was the cancer contained in the prostate...maybe back then they did not have MRI with coil or spectroscopy which could have identified if the cancer was most likely confined or not...if they could have it seems more options would have been possible. Why did your surgeon say surgery was not a possibility...redundant if the cancer was known or even thought to be outside the capsle.

Thanks

Randy in Indy

Trew
Posts: 891
Joined: Jan 2010

You are an excellent candidate for proton treatment.

I hope you consider if carefully before rushing off to get surgery done.

hopeful and opt...
Posts: 1282
Joined: Apr 2009

I am sorry to hear that you have been diagnosed with prostate cancer; however you are fortunate that there has been a very early dectection of the disease and it is very treatable.

By the way you did not mention your age, general health or the involvement the postive sample, that is what percent of the sample has a gleason 3+3=6

Frankly at this time the PSA is secondary to the biopsy. The biopsy shows what is going on while the PSA is an indicator.

Also a second opinion of your biopsy by another pathologist who is quailified is considered a good idea.

Cryosurgery is generally considered a treatment of last resort, and almost 100 percent of the time ED occurs......sometimes a partial cryo is done, say on one lobe when the cancer is seen there to reduce the ED issue.......however I think that I read that although not dectected in other area, there still can be a cancer.

In my initial diagnosis, I had 2 of 12 core positive which is more than you......I am enrolled in an active surveillance program.....where my second biopsy showed zero of 15 core with any cancer....I am continuing on this program........I have no physical side effects...I can choose a treatment when and if necessary.....there are valid treatments out there.....cryo is appropriate for some at various stages, however, I personally would never never choose cyrosurgery at the early dection level that I have.

Below is the treatments that I have had so far.......currently my pathology has been sent for a second opinion and should be ready about now.

Also I have included a study to show the results of a well known active surveillance study....since then the technology of measuring prostate cancer that one has, has improved, and prostate cancer progression or not, can better be evaluated, so one can make a better decision to choose another treatment option.

Good luck,
Ira

Active Surveillance
Diagnosed 3/09 for 66 birthday
By chance doc found a bump in the cavity , not on the prostate(which turned out to be non cancerous)
PSA's had been at 2.26/2.27 for a few years
Biopsy 3/09 Gleason 3+3=6 2 of 12 cores positive- 5 percent involvement in each
second opinion john hopkins
4/09 MRI(tesla 1.5) with spectroscopy, no nodule involvement, staged t1
Aureon molecular test on biopsy, 97 percent chance will not progressin next 8 years
PSA Jan 2.2, JUly 2.5, November 2.6, February 2010 2.0
Entered in a research study for active surveillance at UCLA.
PSA at UCLA, 5/24/10....different institution than had previously used (will go back to the other group that I had been going to better compare PSA's over time
June 2010 ...MRI(tesla 3.0)
June 2010.....Three dimensional targeted biopsy ( based on MRI and ultrasound ability from this biopsy)......15 cores of which 3 are targeted....no cancer found.

Here are some results of Lawernce Klotz,MD, well respected
new
active sureilance expert

protocol:

PSA and DRE every 3 months
Prostate ultrasound every 12 months
Repeat biopsy at month 12 and 36

After 8 years:

- 55% remain untreated with stable disease

- 36% decided to have treatment(eventhough they did not have progression)

- 9% treated with surgery or radiation for increase in psa or gleason score

- none have metastatic disease
< 1% men died of prostate cancer

---------------------------------------------------
Analysis of Bill Axelson by Lawernce Klotz, MD
Journal of clinical Onchology 2005

. lower gleason
. less than 1/3 cores and none >50%
. PSA < 10 and not rising
. PSA density < 0.15
. no palpable diesease
. early treatment for any progression

FOR LOW RISK, 100 SURGERIES WILL SAVE 1 LIFE 10 YEARS IN THE FUTURE

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