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

If you're asking if proton has ever been used for initial focal therapy - I've never heard of that. I think Mitchell Kamrava had a clinical trial of focal HDR brachy, but he couldn't get enough patients enrolled. LDR brachy and SBRT could theoretically be used for initial focal treatment - and there is a pilot clinical trial for those. Theoretically, a surgeon could just cut out the index tumor, as is done with most other cancers. There are many focal thermal ablation techniques that have been tried: FLA, cryo, HIFU, PDT, RF,MW, and plasma, as well as IRE, a non-thermal ablation technique.The issues are much the same - PC is almost always multifocal, and even the best imaging can't detect all the cancer; and damage to nearby healthy tissues. Multiple treatments multiply toxicity.

- Allen

I haven't been following this post as much as some but having gone through a couple of years of AS and then needing a RP, I have a few comments.
As the computer in the movie War Games said - "the best option is not to play" (addressing thermonuclear war).
Unfortunately for all of us on this page, the "war" came to us so we are stuck playing.

I was diagnosed with PCa after a biopsy performed as the result of an erroneous notation following a DRE. Imagine my surprise - my PSA never got above 3.7. The biopsy was a standard, random sampling type, and identified my PCa as Gl-3+3, which was then confirmed a year later by a second random biopsy. After the first biopsy, my doctors agreed that AS was the best option, along with the annual biopsy routine.

By the 3rd biopsy, I changed to a facility that performed MRI (w/ contrast) and coupled that with the biopsy to allow more, non-random sampling. That biopsy targeted the area identified in the MRI and my whole world changed. I was now a Gl 3+4, and the doctors said under no conditions would they agree to continue AS.
My choice at that point, due to the size and location of the tumor was surgery or radiation; I wasn't even told about any ablation options that might exist because of the location.

Gunsmoke - Here is my take-away for you:
- Do not just depend on Doctors for your decisions. This site is a wonderful source of real-world experience. You find out things here that you wouldn't find in a whole week-long meeting with most doctors.
- Get a new MRI-combined biopsy ASAP. Had my initial biopsies been this type I might have had other options before the tumor's size/location became critical.
- DO NOT continue AS with a Gleason as high as you listed - regardless of what your doctor may say. This is critical and potentially irreversible by the time AS is discontinued.
- As Tall Allen has stated, the ablation therapy techniques are not practical when you have a high Gleason score.
I wish that it was not the case, but our medical communities' understanding of the PCa variables is elementary at best.
My GP once told me (but I didn't understand until well into the PCa issue) that you should think of medicine/doctor specialties as a high rise medical building. If you get off the elevator on the surgical floor, your problem will require surgery. If you get off on the radiation floor, you will be diagnosed for rad treatments. The internal medicine floor will help you understand how your stomach and colon caused your problem. If you get off on the nutritional or natural therapy floor, you will get a special diet to solve your issues. And god help you if you get off on the research floor.

You need to find a doctor who is knowledgeable about all of the options available and is willing to provide a patient advocate role. This is sometimes very hard to find, since everyone is so specialized these days.

You have my best wishes for finding the most "correct" options for your situation,