Experience with Focal Cryotherapy

Has anyone had any experience with focal cryotherapy where the specific tutors are targeted and frozen? I have read the side effects on incontenence and ED are reduced, the procedure leaves the door open for future cryotherapy, surgery or radiation if necessary.

I could find this is being done in Colarado, Florida, and there were some you tube videos suggesting it is being done at Sloan Kettering.

Thanks Ziggy,

interesting they waited two months between the 3d mapping until the TFT? In my case, I am being told two days between procedures.

My Rectal MRI shows two tumors, left and right side, biopsy 4 of 12 positive, three are 3+3, the fourth is 3+4, 10%. I am 48.

I am trying to figure out the downside of this procedure and why more of these are not being performed. Seems like getting a filling vs pulling out the tooth. I postpone RRP while technology continues to improve.

Wolfster said...
Thanks Ziggy,

interesting they waited two months between the 3d mapping until the TFT? In my case, I am being told two days between procedures.

My Rectal MRI shows two tumors, left and right side, biopsy 4 of 12 positive, three are 3+3, the fourth is 3+4, 10%. I am 48.

I am trying to figure out the downside of this procedure and why more of these are not being performed. Seems like getting a filling vs pulling out the tooth. I postpone RRP while technology continues to improve.

Two days??? Something isn't right there. It's SOP after a normal 12 needle biopsy to wait at least 6 weeks before most treatments. Although 3D mapping saturation biopsy goes through the perineum and not the colon healing is still needed. Especially with the amount of needles, I had 45 and I've heard as many as 90 depending on the size of the prostate. Do not get this done with only a 12 needle biopsy. That's nowhere near enough to best locate your entire amount of detectable PCa. Where are you having this done? Your stats are borderline in qualifying for targeted treatment to begin with. University of Colorado was the lead site in developing not only TFT but also 3d mapping and software. The last I heard only about 59% post 3D biopsy qualify to go on with the others needing more aggressive treatment. My doctor who is also the director of research here has done about 700 procedures I was #57 back in 2008. He also was the first to use a laser for it.
alprostate.com/yahoo_site_admin/assets/docs/laser_prostate_surgery.7155943.pdf

Reasons for why this is not more popular are the following. Of course for the "get it out of me stat!!!" crowd this doesn't work. Also there are few sites to have it done. The biggest reason according to the doctors here and it's a sad one is there isn't simply enough money in it. That's a sorry statement made and indicates our for profit medical industry we all struggle against. Also many who now qualify for TFT elect AS. In fact back in late 2007 many here thought I had a death wish electing to join in the TFT clinical study for back then surgery was the "gold standard", even brachytherapy was looked down on. My how times have changed. If I was diagnosed now I'd likely choose AS too to be honest with you, but I have no regrets choosing TFT if for no other reason just my playing a part in a truly 21st century treatment. One of the best reasons for choosing AS I always say is to see what new develops in PCa treatments. In addition I was so lucky to learn about TFT soon after my original biopsy and to be located in an area where one of the top U.S. urologists and his staff were early on record to believing there was massive over treatment of men with indolent Pca. Or treating men more likely to die with PCa than of it.
As far as commensurate cost mentioned in the post above all I can say is nonsense. I and the others who I have talked to before all have the same story told post treatment. Life goes on as before the only side effect is a loss of variable percentages of ejaculant. That's why I always say I am the most successfully treated man posting here. Remember it's now been over seven years. Plus I have no idea what scar tissue the poster above is talking about. The actual TFT are just needles inserted through a brachytherapy grid through the perineum.

Post Edited (Ziggy9) : 8/21/2015 8:56:40 AM (GMT-6)

For certain well-selected candidates, I think it's a great option. The biggest upside is that it can make active surveillance a lot easier to tolerate. At best, it removes the index tumor, and may slow down or prevent growth of other smaller tumors. But there are several downsides:

• It has a very high rate of recurrence vs radical therapies. Often, one other treatment is necessary, sometimes more. It should be viewed as an adjunct to active surveillance rather than a cure. You'll have to be monitored permanently.
• 80% of PC is multifocal - often too small to see with any kind of imaging. The theory of an "index tumor" that is the mother of them all is far from proven, and may be true only for some.
• Thermal ablation (like cryo) doesn't have complete cell kill, especially at treatment margins where viable cancer cells can hide out for a long time.
• Thermal ablation does not stop on a dime - it can kill a lot of nearby healthy tissue - so it should not be used near vital structures like the bladder neck, urethra or rectum. Most doctors won't treat you with multiple positive biopsy cores. My Uro, who does, FLA, limits it to two.
• We have very little long-term data.
• Salvage is difficult.

That said, there have been many technological improvements, especially in mpMRI imaging to delineate the borders of the tumor. Focal laser ablation is probably the most popular of the new focal therapies; it is probably the easiest to go through.

Wolfster, here's my $.02...

I'm not all that familiar with focal cryotherapy, as has been said, there just isn't much being done. When the original cryotherapy was developed back in the early 90's, my father was one of the early patients at Cleveland Clinic. After a lot of early promise, that particular version of cryotherapy as primary treatment has slipped to the wayside.

I'm one who is a living breathing commenting positive surgery story. There are many, many men out there who have had surgery and had minimal SE's. We're out there, and we're real. My view is that if you're reasonably healthy going in and don't have major urinary or ED issues before surgery, you've got a great chance to come through well.

Ziggy,

I think you mistake my calls for going in with one's eyes open for a condemnation. The OP asked "why more of these are not being performed," and I attempted to answer that. I am neither a booster, as you are, nor am I the detractor you take me for.

While you were lucky to not have a recurrence, and therefore require less monitoring, recurrence rates are much higher for focal cryo than for radical therapy. Aaron Katz, one of the best practitioners having treated 126 patients, reported biochemical recurrence in 29% of his focal cryo-treated patients. He notes that patients with more than 2 positive cores were most likely to recur. Comparable low-risk patients treated with surgery or radiation have biochemical recurrence rates of about 5%. Or they can be safely monitored with Active Surveillance, and experience no side effects.

When one has a recurrence after focal therapy, they simply repeat the process (which is also true after radical radiation). Like all salvage therapies, the side effects of treatment accumulate with each salvage. At what point is re-treatment no longer possible? And then will salvage radiation or salvage surgery still be possible? These are difficult questions to answer at this stage.

Across the Cold Registry, 42% of patients had new onset ED after focal cryo, Katz reports 32% in his practice. Comparable numbers for SBRT and HDR brachytherapy are 20-25%.

I very much encourage people to try new therapies in the context of a clinical trial or a registry (like the Cold Registry). In fact, I did it myself. I recognize, however, that many patients prefer the tried-and-true, and there's nothing wrong with that either. It's just personal preference.

My Uro (Leonard Marks) is doing a clinical trial of FLA at UCLA that you might qualify for. Insurance companies tend to look kindly on clinical trials, and the costs are less anyway. Here's the info:

Focal Laser Ablation of Prostate Tissue (FLA)

I think he told me two positive cores are max, but he might've meant two tumors - call and ask - nothing to lose. Your post above says Gleason 3+4, not Gleason 8. I know he is very fussy about the location of the tumors.

There are more focal options, and more radical treatment options beyond cryo and surgery.