Cryotherapy as first course of action?

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Bill_in_Portland
Bill_in_Portland Member Posts: 4
in Prostate Cancer #1

Im 63 white male with a PSA of 4.31, clinical stage T2a and Gleason score of 4+3=7. Biopsy showed 5 of 12 cores, all on right side. PTI was 1 to 5% for 4 cores and 60% for one.  All came back as perineural invasion not identified. Currently scheduled for RP surgery by Davinci in 6 weeks. A friend's father swears by Cryotherapy as a success after a reoccurence following radiation treatment ten years ago. Given my condition is cryotherapy an option or is it reserved for reoccurence after radiation? Is there any other imaging performed now that would assist surgeon in operating room?

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  • hopeful and optimistic
    hopeful and optimistic CSN Member Posts: 2,346 Member
    edited October 2017 #2
    .

    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.

     

  • Swingshiftworker
    Swingshiftworker CSN Member Posts: 1,017 Member
    #3
    Risk of ED Higher

    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.

  • Clevelandguy
    Clevelandguy CSN Member Posts: 1,336 Member
    #4
    Get the tests done

    Hi,

    The MRI should guide the doctor(s) doing what ever proceedure you choose.  Talk with a urologist and see if he reccomends any additional testing if you are sticking with surgery.  Also might not hurt to get a second opinion with another oncologist or urologist to see what they recommend.  Both radiation & surgery have side effects mostly incontinence & ED, check out other posts on this forum to get the straight story.

     

    Dave 3+4

  • Clevelandguy
    Clevelandguy CSN Member Posts: 1,336 Member
    #5
    Choice?

    Hi,

    If you want to do the cyro then I would do a lot of study on it and also see if you doctor can let you talk to some cyro patients to get their viewpoint.  Need to also look and see what is after(treatments) cyro if that fails to keep the cancer at bay.

     

    Dave 3+4

  • Old Salt
    Old Salt CSN Member Posts: 1,653 Member
    #6
    The 'official' word from the AUA

    Whole Gland Cryosurgery

    1. 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)
    2. 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)
    3. 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)
    4. For whole gland cryosurgery treatment, clinicians should utilize a third or higher generation, argon-based cryosurgical system for whole gland cryosurgery treatment. (Clinical Principle)
    5. 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)
    6. Clinicians should inform localized prostate cancer patients considering whole gland cryosurgery that erectile dysfunction is an expected outcome. (Clinical Principle)
    7. 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)

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