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Anyone had focal cryotherapy? or a patient of Aaron E. Katz, New York?

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Posted 8/15/2015 7:15 PM (GMT 0)
My dh is interested in focal cryotherapy/cryosurgery/focal ablation, etc. and we are wondering if anyone here has had it done. Also wondering if anyone is a patient of Dr. Aaron E. Katz, New York. Thank you for any help you can give.


(signature in draft form)
Age 65 (8/15) Very Good health other than the below:
PCa Diagnosed 7/2013; Gleason 7 (4+3) Stage 1; 15% of one of 12 biopsy samples positive,
PSA: 10/2008 3.5; 6/2010 4.4; 9/2012 9.5; 7/2013 8.6; 2/2014 7.1; 6/2014 9.7; 7/2015 8.5
Breast Cancer, IDC: R side, Diagnosed 7/2014, AJCC Stage IIB; TII; Nottingham Score: Grade 3; 100% estrogen receptive, Mastectomy Surgery 8/2014, clear margins, 1 of 3 nodes positive
Melanoma; L Shoulder, Diagnosed 6/2014 , Stage II; Surgical removal 8/2014, clear margins, clear nodes
Following Gerson juicing therapy (2 yrs since 7/2013) and Dr. Aaron Katz’s supplement and diet recos for the most part (over the last year).
Posted 8/15/2015 7:30 PM (GMT 0)
He sounds like a good candidate for focal ablation - depending on where the positive core is. Focal laser ablation is popular now - Dr. Sperling in NY does a lot of that. Dr. Coleman at Memorial Sloan Kettering is investigating other kinds. I hope the biopsy slides were confirmed by Bostwick or Epstein. Be aware that repeat procedures within a year or two are very common.
Posted 8/15/2015 9:24 PM (GMT 0)
Tall Allen: Thank you for responding. He hasn't had a repeat biopsy yet. It's been 2 years. Would it be worth getting a second opinion on the slides since they are that old? We are planning on consulting with Dr. Katz. My understanding of the focal cryotherapy is that (as explained in Katz's book) that argon gas is used to freeze the affected areas. Is that different from focal laser ablation? We are in Chicago, do you know of any good docs here for either of these procedures?
thanks again.
Posted 8/15/2015 9:35 PM (GMT 0)
The affected core was from area #7, bottom R near center.
Posted 8/16/2015 3:52 AM (GMT 0)
I'm sorry, I must have had dyslexia when I read the signature and responded earlier - if his core was GS 4+3, I think focal ablation is a very risky treatment. Since his last biopsy was two years ago, I would say the first order of business before any kind of treatment decision is to get a follow-up biopsy, preferably multiparametric MRI-targeted. I guess his doctor let him go two years without f/u biopsy or treatment with such a high grade cancer because he figured that the breast cancer was a more urgent matter. Some high grade prostate cancers never put out a lot of PSA, but that doesn't mean they are any the less virulent, and often more so. I'm sorry you have to put out one fire after another - it must be very draining to deal with all of that.

- Allen
Posted 8/16/2015 2:11 PM (GMT 0)
Gunsmokefan, I responded to your posted in that other place you posted so when you get over their next time, click on Notifications.

I actually was going to message you again today and suggest you head over here and specifically hear what Tall Allen has to say, but apparently you were one step ahead of me. Lol

I think I understand now, why no treatment when first diagnosed.
Tall Allen, while not a Dr is probably the most knowledgeable member here , technically speaking, so take what he says seriously, and use it to ask the docs hard questions.
Posted 8/17/2015 8:11 PM (GMT 0)

GunsmokeFan said...
Tall Allen: Thank you for responding. He hasn't had a repeat biopsy yet. It's been 2 years. Would it be worth getting a second opinion on the slides since they are that old? We are planning on consulting with Dr. Katz. My understanding of the focal cryotherapy is that (as explained in Katz's book) that argon gas is used to freeze the affected areas. Is that different from focal laser ablation? We are in Chicago, do you know of any good docs here for either of these procedures?
thanks again.

I had TFT (targeted focal therapy) done 8 years ago and I remain the most successfully treated man on this site. It was done by argon tipped needles although my doctor who is also the director of research at CU medical has done a few by lasers too, but over 700 by argon. I was #57 in the clinical study in Denver.
Posted 8/17/2015 11:12 PM (GMT 0)

GunsmokeFan said...
My understanding of the focal cryotherapy is that (as explained in Katz's book) that argon gas is used to freeze the affected areas. Is that different from focal laser ablation? We are in Chicago, do you know of any good docs here for either of these procedures?

They are almost opposites. With cryo, cooled argon is used to ablate the tissue, and they use a warming gas like helium to prevent excess damage to surrounding tissue. Lasers, on the other hand, heat up tissue to destroy it. They are both called "thermal" in the sense that tissues are destroyed by heat or the lack of it. Other forms of thermal ablation are photodynamic therapy, radiofrequency, microwave, and high-intensity ultrasound.

Because heat (or cold) travels, they all share the risk of destroying healthy tissues, so you wouldn't want them if the tumor is close to the NV bundle or the urinary sphincter, rectum, or bladder neck. They also may incompletely treat the tumor, so there is a high degree of recurrence relative to radical therapies. Because of that and because prostate cancer is multi-focal 80% of cases (even if the other foci of cancer are too small to be detectable by current technology), it is especially a poor idea for unfavorable risk cancers like your husband's. Because of that, and because his cancer may have spread considerably over the last two years, focal ablation of any kind is not a good therapy for him now. As I said, he really has to have a repeat biopsy before deciding on any therapy.

- Allen
Posted 8/23/2015 1:19 AM (GMT 0)
Allen and Ziggy9,
I've been out of town this week. Thank you for your responses. There is so much to learn; I appreciate all this information and I am taking it all in.
Posted 8/23/2015 2:16 PM (GMT 0)
How did your meeting go with Dr Katz?
Posted 8/24/2015 7:07 PM (GMT 0)
Hello Pratoman,
Wife here; it went fairly well. Dr. Katz said my husband should continue the healthy eating & supplements he has been doing; hee was pleased that PSA is staying stable; thought he would be a good candidate for the active surveillance program at this point and not necessary to decide on any more treatment. He thought the biopsy of 2 years ago was sufficient at this point. Ordered an MRI just to rule out any concerns. He had that later in the week, last week, there in NY. I personally was disappointed that I wasn't given enough time for my questions even though I asked in the beginning whether there would be time for questions and Dr. Katz said yes. I felt like we were pushed out before I got many questions answered. My husband asked a question or two and then I asked a couple of questions. Dr. K said he had meeting to get to at 4:30 (it was then about 4:15). Our appointment time was 3:30. By the time we got in I would say our appointment lasted about 30-35 minutes. My husband specifically chose an appointment time that was his last appointment of the day hoping we would have ample time.
We were grateful and relieved to know that Dr. K thought my husband was a good candidate for active surveillance at this time, even though my dh asked about the focal cryotherapy.

(current draft signature, I need to shorten it before I can use it as a signature apparently)
Age 65 (8/15) Very Good health other than the below:
PCa Diagnosed 7/2013; Gleason 7 (4+3) Stage 1; 15% of one of 12 biopsy samples #7 positive.
PSA: 10/2008 3.5; 6/2010 4.4; 9/2012 9.5; 7/2013 8.6; 2/2014 7.1; 6/2014 9.7; 7/2015 8.5
Breast Cancer, IDC: R side, Diagnosed 7/2014, AJCC Stage IIB; TII; Nottingham Score: Grade 3; 100% estrogen receptive, Mastectomy Surgery 8/2014, clear margins, 1 of 3 nodes positive
Melanoma; L Shoulder, Diagnosed 6/2014 , Stage II; Surgical removal 8/2014, clear margins, clear nodes
Following Gerson juicing therapy (2 yrs since 7/2013) and Dr. Aaron Katz’s supplement and diet recos for the most part (over the last year).
Posted 8/24/2015 8:27 PM (GMT 0)
Active Surveillance with a Gleason 4+3??? I don't think there is an active surveillance program in the world that would allow that, other than if life expectancy is low (and then it would be "watchful waiting"). In fact, that's a very universal indicator that it's time to come off AS. I can only imagine that he rushed through reading the charts and didn't notice that very important fact. I'm sorry you got the bum's rush and hope you get the chance to explore your questions in greater depth.

I always ask docs what is the best way to ask follow-up questions. My preference is direct email. Some docs prefer a screened email or phone calls. Whatever the mutual preference, you should be allowed to follow up. There are plenty of other doctors if he won't allow that.

- Allen
Posted 8/24/2015 11:30 PM (GMT 0)
Agree with TA. I would be doing something other than AS at a (4+3). Perhaps it was the fact that it was only 1 core of 12. But still, 20% with the majority grade 4, i would get another opinion. JMHO
Posted 8/27/2015 1:36 AM (GMT 0)
Thanks gentlemen for your input. My husband has been having a busy week at his job and hasn't yet had a chance to view your responses...hopefully he can tomorrow
Posted 8/27/2015 10:16 PM (GMT 0)
I would normally be in favor of low risk patients considering AS as their first choice of action.

But, I have to agree with Tall Allen and Pratoman that the G 4+3 finding would rule out AS and mandate a form of intervention, such as surgery or radiation.

All due respect, but your doctor's advice does not add up. I suggest that you get a second opinion.
Posted 9/1/2015 3:36 PM (GMT 0)
Thank you ASAdvocate for your response. We will consider all of the contributions and appreciate them.
Posted 9/23/2015 9:34 PM (GMT 0)
GunSmoker,

I would suggest Dr. Scott Eggener at the U of Chicago for a second opinion.

Best,

Doug
Posted 9/24/2015 6:11 PM (GMT 0)
Doug (Soby)
thank you for that suggestion! Have you been a patient of his or how did you come to know of Dr. Eggener?
sharon (GunsmokeFan's wife)
Posted 9/24/2015 9:40 PM (GMT 0)

Tall Allen said...
Since his last biopsy was two years ago, I would say the first order of business before any kind of treatment decision is to get a follow-up biopsy, preferably multiparametric MRI-targeted.

This.

Without a current MRI targeted, MP biopsy and having that read by Epstein, at Johns Hopkins or Bostwick you may well not have the information needed to be making the best decision for the appropriate treatment of your husband.

The doctor selected is very important. However, I think it is safe to say that one of the major things I have learned so far here is that you and your husband are your best advocates to select the appropriate path.

Granted, I am new here and not yet a member of the club. Even so, I have been doing a great deal of reading in the forum and this aspect truly permeates the threads in this forum.

In another thread on the front page today, the comment is made that there is really no one specialist that a patient can turn to in order to select the best path for appropriate treatment for an individual (or words to that effect.)
Posted 9/28/2015 8:23 PM (GMT 0)
Ken,
thank you for this input; it is appreciated . I'm curious also to read the front page post (as of 9/24/15 when you posted. Can you tell me how to find that?
Posted 9/28/2015 8:35 PM (GMT 0)
https://www.healingwell.com/community/default.aspx?f=35&m=3502074&g=3502130#m3502130

this post.

The whole thread is a great read.
Posted 10/2/2015 11:25 AM (GMT 0)
I have a question about these focal type non ionizing radiation treatments... My understanding is that they are very localized in action and work somewhat from the 'inside-out'; does this mean that in the event of failure (be that sooner or later), they leave all the other more mainstream options largely viable e.g. Surgery and RT (in its various favors)?

I ask because of the complications early RT 'can' introduce to downstream surgery... Which this would seem to negate or at least minimize?

If so, it would seem very appropriate as a first-line treatment for ostensibly focal, lower risk disease?

Paul :o)
Posted 10/2/2015 5:49 PM (GMT 0)
Paul,

Surgery after either ablation or radiation is very difficult and should only be done by a few experts, if at all. They both cause tissue changes that may make later surgical removal difficult. In both cases, a much better salvage solution is more of the same. In fact, focal ablation has very high rates of recurrence, often within a year or two, and it is expected that a second treatment may be necessary. After a local radiation failure, salvage brachytherapy, salvage SBRT or salvage cryotherapy have been used.

- Allen
Posted 10/2/2015 6:15 PM (GMT 0)

Tall Allen said...
Paul,

Surgery after either ablation or radiation is very difficult and should only be done by a few experts, if at all. They both cause tissue changes that may make later surgical removal difficult. In both cases, a much better salvage solution is more of the same. In fact, focal ablation has very high rates of recurrence, often within a year or two, and it is expected that a second treatment may be necessary. After a local radiation failure, salvage brachytherapy, salvage SBRT or salvage cryotherapy have been used.

- Allen

Hmmm, shame; "darned if you do and darned if you don't..."!
Posted 10/2/2015 7:57 PM (GMT 0)

Tall Allen said...
Paul,

Surgery after either ablation or radiation is very difficult and should only be done by a few experts, if at all. They both cause tissue changes that may make later surgical removal difficult. In both cases, a much better salvage solution is more of the same. In fact, focal ablation has very high rates of recurrence, often within a year or two, and it is expected that a second treatment may be necessary. After a local radiation failure, salvage brachytherapy, salvage SBRT or salvage cryotherapy have been used.

- Allen

Am I correct in thinking that your statement includes Proton Beam Therapy also? It being a type of radiation, which I have been thinking can sometimes be shaped precisely to the size of the tumor? Supposedly one of it's advantages.

As Paul says, darned if you do, and darned if you don't.
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