Focal Cryo Therapy for initial treatment
After months of indecision, I just sent a note to my doctor at Fox Chase to ask him to schedule me for focal cryotherapy procedure. So far, it seems for primary treatments of Pca, focal treatments are typically only applicable to some men who qualify with in-gland non metastasized low to intermediate grade cancer. The lesions need to be well defined and suitably positioned along with other limiting factors. With all the staging I've had and the index lesion being in a good position I was fortunate to have the option of focal therapy. It is not totally without risk, but much less so than the RP or RT especially concerning side effects. I went to Fox Chase initially because they had recently ran a clinical trial on IRE nanoknife which I thought a good technology mainly due to it's not damaging surrounding structures. Unfortunately I was too late for the study. They can do the procedure, but insurance won't pay for it. It will however pay for cryo. From what I've been reading, cryo is FDA approved, and very effective if done correctly. Although there isn't much long term data yet, the short term data is very promising.
I think all the focal therapies have a higher incident of recurrence when compared to RP or RT, but a tradeoff of much less side effects. Only the diseased part of the prostate is ablated so a new cancer could arise. It can be repeated and you still have the option of RP or RT if it fails. Also, I've read studies have shown that cryo is better at killing cancer cells that are radiation resistant.
I'm guessing some of you might disagree with my choice. I have been stressing over and vacillating between RP, RT, and focal since last November. I'm hopeful and feel some relief just having made a decision. I believe the toughest decision I've ever made.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477459/
Comments
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Full speed ahead! I am selfishly interested in your path, both focal therapy and Fox Chase.
I had a HoLEP procedure for my BPH, knowing I had PCa going in. I guess you could kind of call it a focal procedure in that they removed some of the prostate, not all of it. In my case, 100cc of a 140cc prostate. Lots of research shows it doesn’t adversely impact later cancer treatments, and in fact probably helps. I’d hope for and expect similar for you, with at worst case pushing off treatment and side effects a whole bunch of years.
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u are very correct about lots of things let it be known that I will say this in every reply cribiform cancer is radiation resistant I’m living proof I did radiation, external beam, and it failed. It failed to damage and kill the cribiform . now. That being said I I have the option to freeze it freezing it would give me a 50% chance of beating it Remember this is my second chance removing it by surgery salvage surgery give me up to 70% chance …cryotherapy it’s a very good first option if you qualify for it meaning age PSA all that good stuff forgive me he did not read all of your threads. I don’t know if you have crib form or not but even if you do freezing it kills instintly ..a good choice ..u dont have to wait long to see if it works ..i believe your psa should drop under 0.9 and stay there within a few months not years like radiation
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Wow! Your manhood was way bigger than mine. Lols! Mine is 37cc. Was the Holep procedure easy or difficult to tolerate? I think I read where cryo may not be recommended for men with very large prostates. Not sure why? So yes, the Holep reduction should be a plus. You may be a candidate for a focal treatment if needed. You may have told me this before, but I can't remember without searching the forum. I suspect you have low volume of 3+3 or 3+4 and you're actively surveilling? Of course I'm hoping to get lucky and have a one and done procedure. Wishful thinking on my part. More likely be lucky just kicking the can down the road. Anyhow, thank you for commenting. I will continue to post as my Fox Chase adventure unfolds.
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Yes Steve, I had a 4+3 with cribriform pattern noted on my pathology report. Another reason I'm initially shying away from radiation. Your comments on here alerted me to investigate cribriform. I had not even heard of it before your mentioning. Glad to hear you're doing OK after all you have dealt with. Hopefully your pathology report will be a good one.
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I’d say the HoLEP was easy to tolerate. It took really 90 days for everything to sort itself out. With a HoLEP, I went from stuffed up urinary tract to free flowing, and the system had to adjust.
I’d use the 90 day marker as a target for your recovery, not sweating the load on any odd things going on immediately after. They too shall pass.
Has your doc suggested a possible trajectory for your PSA?
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After months of indecision, I just sent a note to my doctor at Fox Chase to ask him to schedule me for focal cryotherapy procedure.
Glad to see you made a decision. Full steam forward!
We hope to see your comments on the procedure in due time. They will be valuable to all of us because focal cryotherapy is relatively new. Will you be in a trial?
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Hi Old Salt, Yes, focaltherapy for Pca is "relatively" new, but not brand new. The medium term data is very encouraging for several of the technologies. I believe advances in imaging has been the main driver. Just about all of the major cancer centers now offer some form of focal treatment for qualifying patients. Hifu and Cyro being FDA approved seems the most utilized. In recent years it has been gaining acceptance. There is currently a prostate cryo study at MD Anderson in Texas, but logistically out of the question for me. I am not in a clinical trial. I will most definitely be posting my experience with Fox Chase.
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Have not yet discussed details about PSA monitoring. He did articulate that post procedure will require routine careful monitoring, and another biopsy at some point. I'm going to ask him if subsequent PSMA PET scans might be an alternative to biopsies? Seems to me that should be an option? On this note, I've found with several doctors I have dealt with so far they don't seem to champion the PSMA PET scans. I had to practically beg them to write a script. From what I've been reading the PSMA PET scans are a game changer in being able to locate prostate cancer . I have to wonder if it's just reluctance to change or is there a more definitive reason? Perhaps insurance is not covering them? My insurance United Healthcare Choice Plus payed for it.
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me too you are definitely on the right path ..yes like me if u have a relapse you canhave it removed or even treat it again ..good luck imthink you will do great..how many years experience does the dr doing the cryo have …thats very important it is a very delicate procedure ..fyi dr shinohara ucsf one of the best in the nation 38 years
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Update:
Just got off phone with my Fox Chase Doctor who informed me that they contacted my insurance company and found out that they will pay for the IRE nanoknife procedure. He had said prior that he thought that would be unlikely. Fox Chase recently was part of a clinical with this technology trial named "Preserve". The IRE procedure uses electrocution of the cells and has a claimed lesser risk to surrounding structures when compared to the other ablative therapies. He told me the men having been in the trial are doing well overall.
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you know something I found out a lot about what they told me and when this first started I had an 80% chance of beating this either way slightly lower chance with radiation now that I failed. Take a look and see what the failure rate is of cryotherapy and radiation, is its way more than 20% not I trying to sway you but the goal for treatment if the cancer is in the prostrate is to go for the cure that’s what I was told now I thought I was given a second chance the cancer is still in the prostate so I asked him are we still going for a cure or am I just managing it now and I received the same answer. you may want to look into this when I made the appointment for cryotherapy they sent me all the information. This is what the first paragraph said this is what made me change my mind. Not meant to cure ..u are only 67
Focal cryoablation uses highly pressurized argon gas to freeze tissue such as cancer cells. It is used as the first treatment of choice for a small prostate cancer and to treat patients who failed radiation treatment or other treatments. This treatment option is not meant to “cure” prostate cancer and is more intended to manage the disease.
2. Procedure
a. Theprocedurewillbeperformedundergeneralanesthesia.Anultrasoundprob0 -
Nobody has done thousands of the Nanoknife procedures, but I am betting that team has done thousands of the cryosurgery. The trick is in the positioning, and they have that down cold. No pun intended. No doubt they can hit the index lesion, and that will put you into a status where you can be on active surveillance, possibly cured.
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My Fox Chase doctor stated they do about 4 focal treatments per month for prostate cancer. Including HIFU, Cryo, and IRE. No where near thousands. I'm not sure if they've done any IRE procedures since concluding the "Preserve" clinical trial? They also use Cryo and IRE to treat other types of cancers at Fox Chase so that ups their experience a bit with those technologies. I think focal is a big area of interest to all the major players however. If not, why are they offering it? They know it has much potential or they would not be investing in it. According to my doctor, placement of the probes is a key factor in both IRE and Cryo, but I imagine not the only factor. The technician utilizing the equipment's software would be very important in my opinion. It's a bit of a crap shoot, but I've already waited way too long. The thought of staging with another institution and not being within a relatively local distance is distressing to me. I've read many times to find the best most experienced doctors even if that means travel, but as wise as that sounds, considering with follow up appointments it's logistically impossible for many. As I've stated before, focal is not for everyone and yes there is a higher incidence of recurrence, but the fact that I qualify for it, why not give it a shot. I might get lucky and one and done and have lowered my side effect risks compared to RP or RT as primary treatment. I will still have those options. The down side is; after focal treatment I will be in active surveillance mode. Which the way I'm looking at it, I would still be anyhow no matter which initial treatment I get. Do I make any sense? This doctor I have is very cautious about expressing his opinion even when I ask him directly. He is an oncological urologist surgeon. He has offered surgery as one option along with the others. He even sent me to a Fox Chase Radiologist to discuss radiotherapy. Even after pressing him, he only replies "it's a decision that I have to be comfortable with." My thoughts are "I'm not comfortable with any of them!" Lols! As hard as I have tried to learn as much as I am able, it just seems this decision is a conundrum where logic does not always apply. The amount of information (/ misinformation) and opinions on prostate cancer is daunting. Attempting to navigate it while inflicted with it is incredibly stressful. My stepfather used to tell me "you have to play the cards you are dealt." He was inflicted with Multiple Sclerosis at a relatively young age. It progressed horribly. He never gave up in spirit. He just kept adapting to his symptoms. When I see images of children suffering from cancer, I'm thinking how lucky I am having made it to 67 without hardly a hitch. That said, I'm hoping to beat this thing one way or the other. For me, at this point any of the choices is better than no decision.
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