Cryotherapy as first course of action?

Bill,

Diagnostic tests that I think will be appropriate for you.

what did the digital rectal exam reveal in your case (finger wave that the doc did in your rectum)

What is your psa history.

Your age

Determining Gleason scores are subjective, so you may wish to have your slides sent to a world class pathologist for a second opinion. For the most part your treatment is based on the pathology of your slides. A few world class pathologist are David Boswick, VA, Francisco Civantos, Fl, Jon Epstein Maryland, David Grignon Michigan, John McNeal CA, Jon Oppenheimer Tennessee Dainon Laboratories.....I have these telephone numbers if you so wish.

Image test....it is very important for you to have a 3T multiparametric MRI. This image test may show if there is extracapsular extension, that is, if the cancer has spread outside the capsule..this information is critical in treatment choice.

Also if necessary a PET scan.

..............

There will be 100 percentchance of  eretile dysfuncion with cryotherapy.

Come back to us with the details of your case.

I strongly suggest that you consider a form of radiation. a raadiation oncologist has the ability to extend the perimeter of the treatment beyond the prostate. In your case there is a high chance that the cancer has escaped the prostate. One form of radiation that men on this board have had a lot of success with, with limited side effects is SBRT.

Surgery is for localized cancer, within the prostate. The results are age related, older you are the more side effects. 

The side effects from surgery versus other treatments are the greatest and most severe; erectile dysfuncion, incontinence, etc

Come back with more info and questions

we are here for you.

FWIW, the risk of ED from cyrotherapy is reportedly even higher than for surgery, so if avoiding ED is a concern of yours, you should probably avoid pass on cyro.

Whole Gland Cryosurgery

50. Clinicians may consider whole gland cryosurgery in low- and intermediate-risk localized prostate cancer patients who are not suitable for either radical prostatectomy or radiotherapy due to comorbidities yet have >10 year life expectancy. (Expert Opinion)
51. Clinicians should inform localized prostate cancer patients considering whole gland cryosurgery that cryosurgery has similar progression-free survival as did non-dose escalated external beam radiation (also given with neoadjuvant hormonal therapy) in low- and intermediate-risk disease, but conclusive comparison of cancer mortality is lacking. (Conditional Recommendation; Evidence Level: Grade C)
52. Defects from prior transurethral resection of the prostate are a relative contraindication for whole gland cryosurgery due to the increased risk of urethral sloughing. (Clinical Principle)
53. For whole gland cryosurgery treatment, clinicians should utilize a third or higher generation, argon-based cryosurgical system for whole gland cryosurgery treatment. (Clinical Principle)
54. Clinicians should inform localized prostate cancer patients considering cryosurgery that it is unclear whether or not concurrent ADT improves cancer control, though it can reduce prostate size to facilitate treatment. (Clinical Principle)
55. Clinicians should inform localized prostate cancer patients considering whole gland cryosurgery that erectile dysfunction is an expected outcome. (Clinical Principle)
56. Clinicians should inform localized prostate cancer patients considering whole gland cryosurgery about the adverse events of urinary incontinence, irritative and obstructive urinary problems. (Strong Recommendation; Evidence Level: Grade B)