Latest on IRE Nanoknife Focal experience

swl1956

Thought I'd start a new post and update my Pca journey.

Condensed history: First diagnosed November 2023 with 4+3=7 tumor within gland. Confirmed by 2 biopsies, bone scan, and PSMA PET scan. No metastasis. After local urologist suggested surgery or radiation I got a second opinion from Fox Chase Cancer Center in Philadelphia. They too suggested surgery or radiation, but also offered a third option of focal therapy which due to tumor location and other factors I was a good candidate for. I choose this option due to it's having much lower risk of side effects. IRE Nanoknife ablation was performed May 2024. Procedure went well with the exception of a few days of urinary retention after catheter removal. (Do it yourself intermittent catheters is something I would not wish on anyone.) Anyhow, at time of procedure my PSA was 5.6. Three months post procedure it had dropped to 4.6. Everything was functioning as before with exception of no more ejaculate fluid. Now at 6 months post procedure PSA has risen to 9.3 😪 which my surgeon immediately suggested an MRI. Results below:

Narrative & Impression

Study: MRI of the Pelvis, with and without intravenous gadolinium, with attention to the prostate gland Indication: Prostate cancer status post by IRE Comparison: MRI 10/6/2023, PSMA PET/CT dated 3/28/2024 Technique: Multiplanar, multisequence MRI of the pelvis was performed before and after the intravenous administration of 17ml of Dotarem with attention to the prostate gland. Findings:PROSTATE SIZE: 2.9 x 3.9 x 4 cm (AP x Trv x CC)CALCULATED PROSTATE VOLUME: 24 mL. FOCAL LESIONS: T2 hypointense nodular area in the right lateral peripheral zone at the mid gland measuring 9 x 11 mm (series 5, image 16), with absent enhancement in keeping with nonviable ablation zone. No additional suspicious lesions by PI-RADS criteria. Remainder of the prostate appears similar to previous examination on 10/6/2023, with prominent rounded the pH nodule at the left base and patchy fibrosis throughout the peripheral zone. PROSTATIC CAPSULE: Intact SEMINAL VESICLES: Normal. URINARY BLADDER: Normal.LYMPHADENOPATHY: No enlarged pelvic lymph nodes are identified. BONES: No suspicious osseous lesion.  Impression: 1.Nonviable ablation zone in the right peripheral zone mid gland.2.No additional new suspicious lesions by PI-RADS criteria.

My surgeons response:

"The MRI looks like there is no evidence of any viable tissue in the ablation zone. There are also no new concerning lesions. Although these findings are encouraging, I still think we should move with the biopsy. We are working on getting the biopsy scheduled next week."

I'm wondering if this latest MRI might not have been able to visualize into the ablated area which might be hiding some cancer growth? Perhaps another PSMA PET scan is in order? I have been experiencing some minor discomfort in the lower right groin which I must admit is kicking in my paranoia as hard as attempt to not let it. I'm disappointed this did not turn out a one and done experience, but I don't regret having tried the Nanoknife procedure. A redo or all other options are likely still available to me. Biopsy is scheduled for Dec. 20th. My journey continues. Whoopee!

centralPA

I'm thinking the ablated zone was well and truly zapped. I bet the biopsy sorts this out.

Following your case closely…sending strength for dealing with the uncertainty!

Old Salt

Thanks for posting; the significant rise in PSA is worrisome, of course. Did your surgeon rule out prostatitis? A second PSA seems warranted as well.

I do hope that this issue can be taken care of with minimal intervention.

swl1956

https://csn.cancer.org/discussion/comment/1719420#Comment_1719420

Thanks!

swl1956

https://csn.cancer.org/discussion/comment/1719425#Comment_1719425

I have an appointment Wednesday to discuss further. I was thinking about prostatitis or bladder infection, but I really don't have any definitive symptoms of those. I have been experiencing some very minor pain in the lower right abdomen and feeling fatigued which is adding to my worry level. Thanks for your hope. I could not agree more.

swl1956

Had appointment today at Fox Chase. Doctor showed me the MRI images and explained they do not see any new areas of concern within the ablated zone or anywhere else in the gland. The ablated tumor area appears to be completely toasted. He will be performing a biopsy (#3 for me 😫) next Friday and has written an order for a PSMA PET scan after the first of the new year. He said that he and other urological oncologists have on occasion seen PSA spikes that resolve without any definitive explanations. Being a pessimist, I think that's wishful thinking? 😕 I will meet with him again in January to discuss findings of biopsy and PSMA PET scan. I must admit that I'm second guessing my decision to go Focal. He also informed me that the ablated areas can sometimes cause difficulties when salvage prostatectomies are performed, but is dependent on where the ablated area is. In my case was not an issue. Of course, I'm still hoping that if he finds cancer it's still within the gland.

Old Salt

The earlier PSMA scan didn't find anything, you wrote earlier. Let's hope for a repeat.

centralPA

You made the best decision based on the information you had at the time, and your own inclinations. You were true to yourself. That's all you can be, shipmate.

Does suck that the game continues, though.

fjubier

Again I am sorry you have to go through this merry go round again. I am like you and just had focal and this is a big bet….But I chose focal because it leaves ALL options on the table and you probably have the entire arsenal available. Also I remember reading that very high PSA (not sure about the range if above 20 or 100) could indicate that it escapes the gland. Your PSA level is still low but this is stressful…always wondering what the heck is going. May the force be with you !

Clevelandguy

Hi,

A lot of you survivors are thinking the correct way, always have at least one backup plan. I chose surgery knowing that I would have at least a couple of paths to go down if my cancer returned. Whether its at the office, travel or what ever, I always try to look down the road I may never travel with backup plan A and B and maybe C. It has served me well over my 72 yrs, good luck.

Dave 3+4