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Posted 3/24/2018 4:26 PM (GMT 0)
Would like advice on treatment. Been on AS since 2014 G6 diagnosis. Had follow up biopsy this week based on 3TMP MRI. Lesion that used to be HGPIN is now Gleason 4+3, 2 cores 15% & 50% respectively, 60% of sample exhibits pattern 4. Lesion in right mid anterior transition zone abutting fibromuscular stroma, but self contained within Prostate capsule. 1 additional positive core 3+4, 30% volume in right mid directly adjacent to index lesion. 9 total cores in biopsy. 3 cancerous and one additional HGPIN, left apex.

My question centers upon decision between robot assisted prostatectomy or Focal Laser Ablation. I fully understand that if I choose FLA, that I will continue to incur periodic MRI & Biopsy follow up. I have already been doing this with my AS program and I have no issue with the mental or physical stress that comes along with this regimen.

The issue is solely related to the risk associated with my 4+3 cancer. I have no doubt that the index lesion (4+3) and adjacent lesion (3+4) can be successfully ablated. The question is if other lesions develop, can we reasonably stay on top of this to where we can prevent progression outside of my prostate before recognizing the progression and potentially moving toward the prostatectomy.

I want to avoid prostatectomy for as long as possible due to the fact that my father (who died of 4+3 PC after 21 years last year) had permanent ED after open prostatectomy.

I have a very solid understanding of FLA, because I sell this technology for a living predominately for cranial Neurosurgery.

I firmly believe FLA can work as a cure for some and as a mechanism to lengthen time to avoid prostatectomy for others. But is my 4+3 diagnosis not worth the risk of employing this strategy?

Any feedback would be greatly appreciated.

Thanks,

PC Legacy
Posted 3/24/2018 5:19 PM (GMT 0)

PC Legacy said...
I have no doubt that the index lesion (4+3) and adjacent lesion (3+4) can be successfully ablated. The question is if other lesions develop, can we reasonably stay on top of this to where we can prevent progression outside of my prostate before recognizing the progression and potentially moving toward the prostatectomy.

You should have a lot of such doubts. In the small, short term studies of FLA published so far, cancer recurred in the ablation zone for some and outside of it for more. You should also have some concerns about urethral stenosis with treatment of a TZ tumor. Here's an article about unresolved issues with focal ablation (note the comments as well):

/pcnrv.blogspot.com/2016/12/focal-ablation-unresolved-issues.html

Why have you ruled out radiation? With SBRT you could have just 5 treatments or with HDR brachy monotherapy you can have just 2 treatments and you're done for the rest of your life. With LDR brachy, they would probably want to include EBRT with it. With IMRT or proton, it's a lot of treatments to no better effect, and they would want to include ADT with it.
Posted 3/24/2018 5:38 PM (GMT 0)

Tall Allen said...

PC Legacy said...
I have no doubt that the index lesion (4+3) and adjacent lesion (3+4) can be successfully ablated. The question is if other lesions develop, can we reasonably stay on top of this to where we can prevent progression outside of my prostate before recognizing the progression and potentially moving toward the prostatectomy.

You should have a lot of such doubts. In the small, short term studies of FLA published so far, cancer recurred in the ablation zone for some and outside of it for more. You should also have some concerns about urethral stenosis with treatment of a TZ tumor. Here's an article about unresolved issues with focal ablation (note the comments as well):

/pcnrv.blogspot.com/2016/12/focal-ablation-unresolved-issues.html

Why have you ruled out radiation? With SBRT you could have just 5 treatments or with HDR brachy monotherapy you can have just 2 treatments and you're done for the rest of your life. With LDR brachy, they would probably want to include EBRT with it. With IMRT or proton, it's a lot of treatments to no better effect, and they would want to include ADT with it.

Allen,
I had hoped you would respond, as I know you are truly well informed. You and I have had previous dialogue surround FLA a few years ago when my initial diagnosis was a G6. Should I choose to have FLA, I understand the risks surrounding re-occurence in the ablation zone and I am confident that in the hands of an experienced interventional radiologist that this fear can be negated. If I choose FLA, I will be going to an IR that has personally been involved in more FLA cases than any other IR doing this procedure.

I am not worried about re-occurence in the ablation zone. I am worried about the ability to manage this post procedure from the perspective of additional developing lesions or advancement outside the prostate capsule. I am well aware that PSA will become a less relevant predictor of prostate health after having FLA and that truly the only way to insure accurate prostate status is through additional MRI and biopsy regimens. It is that variability in the follow up treatment that gives me pause.

My father was told that when he had a 4+3 removed via open prostatectomy 25 years or so ago that they got all the cancer and that it was self contained in the capsule. It clearly was not since he died 21 years after his initial diagnosis. Certainly technology has progressed since then. However, is it worth the risk to use FLA to lengthen my opportunity to continue to have an active sex life?

As far as radiation, my Urologist/Surgeon (the chairman of urology at UTSW Med Center in Texas) believes prostatectomy is the way to go, since if it fails the option for radiation afterwards exists. If I move toward radiation immediately and it fails, prostatectomy will no longer be an option. So, I feel as though moving straight to radiation, could limit my longevity, if the radiation fails.

Given how my father's situation played out, I do not wish the same.

Thanks again for your feedback.

PC Legacy
Posted 3/24/2018 6:50 PM (GMT 0)
PC Legacy...
I'm not informed enough to advise on FLA...just a comment though...not intended to push you towards surgery or any other treatment....just to be sure you understand....

Clearly impotence is a risk. But it's not a foregone conclusion. There are many guys on here that have no problem with ED after surgery, me included. I was about 70% about 3 months after surgery. After 3 years I am now 90% without pills, 100% with. More importantly, techniques ate vastly improved since your dads experience.

So don't dismiss surgery for that reason. But of course, as I said, it is a risk. I'm guessing it's a risk with other treatments as well, maybe lower risk.

Also as Allen said, consider various forms of radiation therapy as well. All forms of treatment, including RT, have really advanced a long way

Good luck, please keep us. Informed
Posted 3/24/2018 7:21 PM (GMT 0)

PC Legacy said...
As far as radiation, my Urologist/Surgeon (the chairman of urology at UTSW Med Center in Texas) believes prostatectomy is the way to go, since if it fails the option for radiation afterwards exists. If I move toward radiation immediately and it fails, prostatectomy will no longer be an option. So, I feel as though moving straight to radiation, could limit my longevity, if the radiation fails.

Yes, urologists almost always say that. That's because of their near total ignorance of radiation. While it's true that prostatectomy would not be a good option after radiation failure, there are a number of salvage options that are a lot better, especially salvage focal brachytherapy. You can read about all the options here:

/pcnrv.blogspot.com/2017/09/focal-salvage-ablation-for-radio.html

Like all salvage therapies, including surgery after radiation or ablation, there is about a 50% chance it will work. Given tht salvage opportunities are about equal, what is the chance that the primary therapy will work?

• As you know, for focal ablation, the failure rate is about 30% across all risk categories

• For surgery, you can use the MSK nomogram:
/www.mskcc.org/nomograms/prostate/pre_op
As you can see, your probability of remaining progression free after surgery is roughly 50%

• For HDR-BT monotherapy, the recurrence-free survival for high-risk PC is upwards of 75%:
/pcnrv.blogspot.com/2016/08/hdr-brachy-boost-and-monotherapy-for.html

At UTSW, you have Robert Timmerman - one of the earliest users of SBRT - I can't imagine why you would trust a urologist when you could easily ask him.
Posted 3/24/2018 7:51 PM (GMT 0)
Since you asked....personally, I would not pick either of the choices you presented. With your stats now I would be looking for cure not delay so would rule out FLA. And with concerns about ED, I would go with LDR Brachy, HDR Brachy or SBRT to minimize the chances of ED and incontinence. As Allen pointed out, there are options for salvage after radiation so that worry is a red herring.

The fact that your uro surgeon recommends surgery is not surprising since that's what most of us experienced in our journey. Seek out options from the radiation experts before making any decisions.

Jim
Posted 3/24/2018 9:41 PM (GMT 0)

Tall Allen said...

PC Legacy said...
As far as radiation, my Urologist/Surgeon (the chairman of urology at UTSW Med Center in Texas) believes prostatectomy is the way to go, since if it fails the option for radiation afterwards exists. If I move toward radiation immediately and it fails, prostatectomy will no longer be an option. So, I feel as though moving straight to radiation, could limit my longevity, if the radiation fails.

Yes, urologists almost always say that. That's because of their near total ignorance of radiation. While it's true that prostatectomy would not be a good option after radiation failure, there are a number of salvage options that are a lot better, especially salvage focal brachytherapy. You can read about all the options here:

/pcnrv.blogspot.com/2017/09/focal-salvage-ablation-for-radio.html

Like all salvage therapies, including surgery after radiation or ablation, there is about a 50% chance it will work. Given tht salvage opportunities are about equal, what is the chance that the primary therapy will work?

• As you know, for focal ablation, the failure rate is about 30% across all risk categories

• For surgery, you can use the MSK nomogram:
/www.mskcc.org/nomograms/prostate/pre_op
As you can see, your probability of remaining progression free after surgery is roughly 50%

• For HDR-BT monotherapy, the recurrence-free survival for high-risk PC is upwards of 75%:
/pcnrv.blogspot.com/2016/08/hdr-brachy-boost-and-monotherapy-for.html

At UTSW, you have Robert Timmerman - one of the earliest users of SBRT - I can't imagine why you would trust a urologist when you could easily ask him.

Thanks Allen. I appreciate your feedback and recommendations. Certainly have a big decision on the near horizon and all info you shared will be helpful to help me make the best choice.
Posted 3/24/2018 11:25 PM (GMT 0)
Another data point- the short story:
After deciding I needed to act, my first Urologist recommended surgery. The 2nd urologist I went to, at Moffett Cancer center, also recommended surgery. So then I visited an oncologist radiation specialist at Moffett, and he also recommended surgery for me.
Why? Because of the size of my prostate (126g), and how it was pressing into the bladder.

I chose the best robot surgeon I could find, and am now 4 weeks post-surgery. I had the catheter out after 2 weeks, and am already down to just one pad a day, so I think I will recover continence. As for ED, I am getting 1/3 erections without help, about 1/2 with wife's assistance. Just started daily 5mg cialis, so we'll see, but I remain pretty positive everything is going to work fine...

Post Edited (Ocean Geek) : 3/24/2018 5:30:29 PM (GMT-6)

Posted 3/25/2018 4:03 AM (GMT 0)
I think you are mixing up your identity with your work...feeling quite comfortable with your knowledge...hence creating a sense of security for your self which...may or may not serve you well...other than an initial confidence be cause of your background...and a sense of a heads up and like maybe holding a poker hand with a major wild card{your ablation background} to have this possible edge... You may be better served by paying closer attention to TA...and his data base and check the ego at the door... even your forum title Pc Legacy....hints in a way...that seems more competitive...Hey lets be smart here and get this taken care of wisely...just to get back to ego's...There is not a member on this forum with an EGO as huge as mine...difference is when your 52 vs 75...a fella tends to protect that ego a bit more aggressively....whereas at 75...you tend to realize what you have and and quite frankly do not need to protect it...ya just project it...nature ally...I trust you will receive this feedback...you did say any feedback is appreciated...good luck...as the oldsmobile commercial said a while back...paraphrased..'.this ain't your fathers Pca '
Posted 3/25/2018 5:19 AM (GMT 0)

logoslidat said...
I think you are mixing up your identity with your work...feeling quite comfortable with your knowledge...hence creating a sense of security for your self which...may or may not serve you well...other than an initial confidence be cause of your background...and a sense of a heads up and like maybe holding a poker hand with a major wild card{your ablation background} to have this possible edge... You may be better served by paying closer attention to TA...and his data base and check the ego at the door... even your forum title Pc Legacy....hints in a way...that seems more competitive...Hey lets be smart here and get this taken care of wisely...just to get back to ego's...There is not a member on this forum with an EGO as huge as mine...difference is when your 52 vs 75...a fella tends to protect that ego a bit more aggressively....whereas at 75...you tend to realize what you have and and quite frankly do not need to protect it...ya just project it...nature ally...I trust you will receive this feedback...you did say any feedback is appreciated...good luck...as the oldsmobile commercial said a while back...paraphrased..'.this ain't your fathers Pca '

Thanks for your feedback. The PC Legacy name is not based on ego, but rather the unfortunate family history that I happen to be a part of. There is no ego associated with the fact that my father and I happen to potentially have the same potential fate. Quite the contrary. You are however correct that my bias toward positive outcomes related to a medical therapy that I represent may cloud my judgement. That issue is exactly why I posted what I did, because I don’t not want my bias to interject in what needs to be the most important decision of my life. Before my recent upgrade in severity of my diagnosis, I did believe FLA to be the ideal treatment option, but frankly, I don’t really believe that now is my best option. Hence the outreach to better understand from folks potentially facing similar prognosis. Nothing more. Nothing less. I appreciate the feedback. I only want to find the best course of treatment that can balance my desire to continue an active sex life while concurrently giving me the best option to be beat my prognosis.
Posted 3/25/2018 10:11 AM (GMT 0)
I also don't have any knowledge of FLA to contribute and there are other options other than RP. I choose HDR BT due to success rate, ease of the procedure and minimal SEs. All systems are normal and I am 6 weeks out. They have been normal after about two weeks. The only temp SE I had was urinary burning and an increased sense of urgency to urinate. That has subsided and I think I am better than pretreatment. SOmething to consider if you haven't. Denis
Posted 3/25/2018 10:41 AM (GMT 0)
I, also, made my treatment decision based on my father's experience. He was diagnosed around 1992-93, and chose to make himself a research subject (and paid for it out of his own pocket) in what was then the newest thing-whole gland cryosurgery. Well, he had a number of good years, and then it came back, first with spots on his ureters that finally moved into his spine and killed him.

The first thing out of my mother's mouth when I told her I had been diagnosed was, "don't do anything experimental!"

Honestly, I don't think you'll find a lot of fans of FLA as primary treatment here--we all tend to lean towards data-driven and proven solutions. FLA is not one that falls in that category. I'm one of the many RALP patients who has essentially zero side effects in either the ED or continence categories. I also see a lot of zero side effect reports from the brachytherapy guys (both LD and HD) and the SBRT guys.

What I'm saying is, don't reject any of the current treatments based on what happened with your father 20 years ago. Mainstream treatments are way better than they were then.
Posted 3/25/2018 1:05 PM (GMT 0)
And another data point. I chose RALP because I wanted the gland out and wanted to know what the pathology was (and one node out of 44 excised was positive.) This and a Decipher test mapped out further treatment for me.
Posted 3/25/2018 3:15 PM (GMT 0)

Tudpock18 said...
Since you asked....personally, I would not pick either of the choices you presented. With your stats now I would be looking for cure not delay so would rule out FLA. And with concerns about ED, I would go with LDR Brachy, HDR Brachy or SBRT to minimize the chances of ED and incontinence. As Allen pointed out, there are options for salvage after radiation so that worry is a red herring.

The fact that your uro surgeon recommends surgery is not surprising since that's what most of us experienced in our journey. Seek out options from the radiation experts before making any decisions.

Jim

Thanks for your feedback Jim. Previously I had not seriously considered radiation, but after seeing your comments and others, I do feel as though SBRT is an option that I need to explore. I am certainly not informed enough yet to make any final decision. My concern is that my 4+3 diagnosis with 50% volume of the sample may be an indicator of more aggressive type of cancer. The kind that has a higher chance to return more so than most Gleason 7 cancers. I tried to search for more relevant data specifically related to cure rates for 4+3 cancers with high core sample volumes of 50% or more and frankly have not been able to find specific references to the type of 4+3 cancer that I have. If anyone can share or point me toward clinical studies or other data points that can shed some light on this, I would greatly appreciate it.

Thank you!
Posted 3/25/2018 3:21 PM (GMT 0)

Tall Allen said...

PC Legacy said...
I have no doubt that the index lesion (4+3) and adjacent lesion (3+4) can be successfully ablated. The question is if other lesions develop, can we reasonably stay on top of this to where we can prevent progression outside of my prostate before recognizing the progression and potentially moving toward the prostatectomy.

You should have a lot of such doubts. In the small, short term studies of FLA published so far, cancer recurred in the ablation zone for some and outside of it for more. You should also have some concerns about urethral stenosis with treatment of a TZ tumor. Here's an article about unresolved issues with focal ablation (note the comments as well):

/pcnrv.blogspot.com/2016/12/focal-ablation-unresolved-issues.html

Why have you ruled out radiation? With SBRT you could have just 5 treatments or with HDR brachy monotherapy you can have just 2 treatments and you're done for the rest of your life. With LDR brachy, they would probably want to include EBRT with it. With IMRT or proton, it's a lot of treatments to no better effect, and they would want to include ADT with it.

Thanks Allen. Your recommendation to explore SBRT is something I intend to now consider. Would really like to know how my 4+3 diagnosis with high % sample volume matches up with treatment regimen. Appreciate your reccomendation.
Posted 3/25/2018 3:38 PM (GMT 0)
Have you submitted your slides for a second reading with Johns Hopkins? A different Gleason score could definitely change the course of your treatment.
Posted 3/25/2018 3:56 PM (GMT 0)
Thanks PC Legacy...I get it...I really appreciate the grace of your reply...absolutely...
Posted 3/25/2018 4:00 PM (GMT 0)

SueCAll said...
Have you submitted your slides for a second reading with Johns Hopkins? A different Gleason score could definitely change the course of your treatment.

Not yet. I agree this is something I need to do.
Posted 3/25/2018 5:20 PM (GMT 0)

PC Legacy said...
Your recommendation to explore SBRT is something I intend to now consider. Would really like to know how my 4+3 diagnosis with high % sample volume matches up with treatment regimen.

Timmerman has pushed the dosage boundary on SBRT (which he calls SABR). I think he routinely gives 45 Gy in 5 treatments. (Mine was 40 Gy/5 treatments, and most give 35-40 Gy/5 treatments). Higher doses only add marginally to cure rates, but may increase side effects dramatically (but there's a lot more to side effects than just the dose).

I don't have a lot of info on GS 4+3 specifically. This Philadelphia CyberKnife study included 13 unfavorable intermediate risk patients, and they had 5-yr freedom from biochemical failure of 90%

/www.frontiersin.org/articles/10.3389/fonc.2014.00312/full

Alan Katz reported on 47 "high intermediate risk" patients who had a 7-year freedom from biochemical failure of 79%:

/www.frontiersin.org/articles/10.3389/fonc.2014.00312/full

Tumor volume is correlated with the other risk factors (PSA, stage, and GS). The MSK nomogram does ask for the % positive cores, which is related to tumor volume. If tumors are very large, I think the danger of hypoxia increases - low oxygen adds to the radioresistance. At the same time, increased oxygenation also protects healthy tissue. One good way to overcome this is to engage in increased cardiovascular exercise while having radiation treatments.

/pcnrv.blogspot.com/2017/12/exercise-may-make-radiation-more.html

There are a few places (mostly in Europe) experimenting with hyperthermia treatment within a couple of hours before radiation to increase radiosensitivity by pulling more oxygenated blood into the tumor.

/pcnrv.blogspot.com/2018/01/hyperthermia-and-radiation.html
Posted 3/25/2018 5:39 PM (GMT 0)

Tall Allen said...

PC Legacy said...
Your recommendation to explore SBRT is something I intend to now consider. Would really like to know how my 4+3 diagnosis with high % sample volume matches up with treatment regimen.

Timmerman has pushed the dosage boundary on SBRT (which he calls SABR). I think he routinely gives 45 Gy in 5 treatments. (Mine was 40 Gy/5 treatments, and most give 35-40 Gy/5 treatments). Higher doses only add marginally to cure rates, but may increase side effects dramatically (but there's a lot more to side effects than just the dose).

I don't have a lot of info on GS 4+3 specifically. This Philadelphia CyberKnife study included 13 unfavorable intermediate risk patients, and they had 5-yr freedom from biochemical failure of 90%

/www.frontiersin.org/articles/10.3389/fonc.2014.00312/full

Alan Katz reported on 47 "high intermediate risk" patients who had a 7-year freedom from biochemical failure of 79%:

/www.frontiersin.org/articles/10.3389/fonc.2014.00312/full

Tumor volume is correlated with the other risk factors (PSA, stage, and GS). The MSK nomogram does ask for the % positive cores, which is related to tumor volume. If tumors are very large, I think the danger of hypoxia increases - low oxygen adds to the radioresistance. At the same time, increased oxygenation also protects healthy tissue. One good way to overcome this is to engage in increased cardiovascular exercise while having radiation treatments.

/pcnrv.blogspot.com/2017/12/exercise-may-make-radiation-more.html

There are a few places (mostly in Europe) experimenting with hyperthermia treatment within a couple of hours before radiation to increase radiosensitivity by pulling more oxygenated blood into the tumor.

/pcnrv.blogspot.com/2018/01/hyperthermia-and-radiation.html

Thanks Allen. Most helpful.
Posted 3/25/2018 11:32 PM (GMT 0)
Dear Legacy, I have a 4 + 3 and am exploring SBRT and Brachy HDR and will decide very soon between them. I also looked into Focal therapy a bit and was planning to do that before I got my 4+3 and new 3 +4's. I am a novice but I like thinking freely, so take the following with a grain of salt.

I read about focal HDR brachy for low risk, intermediate risk, or high risk PCa but only if there is "low volume" of gleason 4 if I understood correctly. That was on youtube, grandrounds, Brian Moran (Chicago Prostate Center). I had not seen focal for high risk before. Moran reports very low side effects like other focal therapy as long as there is sufficient tissue which allows functioning, or that seems to be the idea.

I do wonder, "what is 'low volume'"?

I've been listening to presentations of a Canadian RO, Juanita Crook also on GrandRounds, Youtube. She is using "Total Volume of pattern 4" as potentially more predictive than highest Gleason score which often seems to be more predictive of outcomes than percent cores and staging. I studied with a professor who taught theory-building at university of chicago for 30 years so I am attuned to the formation of new concepts. When I heard Dr. Crook using this concept, it immediately seemed like the new concept I learned to listen for. I don't know whether this is Crook's concept or coming from someone else.

I'm trying to figure out how to calculate total volume of pattern 4. I imagine starting with the volume of the core in which there is a pattern 4, then multiplying by % carcinoma, and then multiplying by % pattern 4, and then adding those from the cores with pattern 4, but like I say, I am just speculating.

I do imagine that the problem of focal is not being able to see or identify the very small pattern 4. MRI doesn't find it. Photo dynamic focal therapy didn't work like they hoped, I understand. Gold nano focal therapy, I'm afraid may have the same limitation.

I wonder if this new method for identifying tiny cancer in the prostate before salvage therapy after surgery (I believe I read something from Allen about that) may end up helping Focal work better?)

Good luck, Manticore
Posted 3/26/2018 3:50 AM (GMT 0)

Manticore said...
Dear Legacy, I have a 4 + 3 and am exploring SBRT and Brachy HDR and will decide very soon between them. I also looked into Focal therapy a bit and was planning to do that before I got my 4+3 and new 3 +4's. I am a novice but I like thinking freely, so take the following with a grain of salt.

I read about focal HDR brachy for low risk, intermediate risk, or high risk PCa but only if there is "low volume" of gleason 4 if I understood correctly. That was on youtube, grandrounds, Brian Moran (Chicago Prostate Center). I had not seen focal for high risk before. Moran reports very low side effects like other focal therapy as long as there is sufficient tissue which allows functioning, or that seems to be the idea.

I do wonder, "what is 'low volume'"?

I've been listening to presentations of a Canadian RO, Juanita Crook also on GrandRounds, Youtube. She is using "Total Volume of pattern 4" as potentially more predictive than highest Gleason score which often seems to be more predictive of outcomes than percent cores and staging. I studied with a professor who taught theory-building at university of chicago for 30 years so I am attuned to the formation of new concepts. When I heard Dr. Crook using this concept, it immediately seemed like the new concept I learned to listen for. I don't know whether this is Crook's concept or coming from someone else.

I'm trying to figure out how to calculate total volume of pattern 4. I imagine starting with the volume of the core in which there is a pattern 4, then multiplying by % carcinoma, and then multiplying by % pattern 4, and then adding those from the cores with pattern 4, but like I say, I am just speculating.

I do imagine that the problem of focal is not being able to see or identify the very small pattern 4. MRI doesn't find it. Photo dynamic focal therapy didn't work like they hoped, I understand. Gold nano focal therapy, I'm afraid may have the same limitation.

I wonder if this new method for identifying tiny cancer in the prostate before salvage therapy after surgery (I believe I read something from Allen about that) may end up helping Focal work better?)

Good luck, Manticore

Manticore,
I too was excited about Focal Laser Ablation prior to receiving my upgraded diagnosis to a 4+3 after my most recent biopsy. I have been on active surveillance for the past 4 years and I was beginning to think my cancer may be indolent. Clearly that is not the case. As for FLA (given that I sell this technology for cranial neurosurgery) I truly believe it can be a great option to lengthen the timeline for low to intermediate risk PC. It is a fantastic option for minimally invasive cranial neurosurgery, to lengthen life for many patients, but is not typically a cure.

As for in prostate, I believe its use will become more common as more data comes available. However, anything with a dominant 4 pattern, along with my 1 core with 50% volume appears to be a bit too much risk for my liking. This Tuesday, I do have a consult with an interventional radiologist to discuss my case, but honestly I am skeptical that this would be wise option for my situation given what I have learned through my recent research.

If I had, perhaps one index lesion that was a 3+4 (instead of my 4+3), I probably would be giving it more consideration. My 4+3 and its 50% volume, coupled with the fact that my father died of a 4+3 cancer will likely steer me toward RALP or SBRT.

Good luck with your decision.

Regards,

PC Legacy
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