Cryo-surgery

Hello,
I had cryoablation in January 2011.
Felt the catheter injured my urethra. My PSA is still good after 5 years.
Have some irritable bladder and have a bit of an urge to urinate sometimes when my bladder is not full. I drink 100 ounces of water a day due to kidney stone history.
I was able to achieve a sexual climax after treatment but have a pre-existing hydrocele that impedes sex. I was told I would not have sexual ability but they were wrong.
I might need a TURP at some point in the future to improve flow.
Good luck.

Just to be clear to others responding, you are having salvage cryoablation after a radiation failure (which is very different from primary cryoablation). Since you went to Mayo, I assume you had a C11 Choline PET/CT to make sure there weren't any non-local metastases - is that correct? I think that it is very important to have some sort of advanced PET scan first to rule out futility of salvage.

Coincidentally, I just reported on the longest running study of salvage cryo after radiation failure:

Salvage whole-gland cryoablation after failure of primary radiation therapy

As you can see, it was disappointing in that 77% of such patients had biochemical recurrences by 15 years later. However, 15 years ago we didn't have the sensitive PET scans that we have today. That might have helped select the men who had only local progression and and who would have been ideal candidates.

The other difference is that it sounds like Dr. Onik will use the mapping biopsy to identify and treat only those areas in which he finds cancer (focal salvage), while in that study, the whole prostate was cryoablated. His focal treatment will probably reduce the incidence of serious complications.

As for the things you were told... Salvage treatment is even more of a specialty than primary treatment, so it is even more important that one seek out salvage specialists. It is not enough that a given doctor is a specialist at surgery or radiation or ablation. And a famous institution is no guarantee. I think Dr. Onik is as expert as one can get in the practice of salvage cryo (I'm sure you asked about his experience and statistics).

- Allen

One big difference between your situation and that study is that they did not use a PET scan to find metastases, so it's fair to guess that many of the treated men already had distant mets and further local treatment was futile. While it's possible that your cancer is micrometastatic and systemic - too small for even that PET scan to find - the odds are certainly more in your favor.

It sounds like Dr Onik is being very careful with you and I don't think anyone is more skilled with salvage cryo.I am intrigued by IRE for this purpose because of its high precision and there is no heat sink effect, but it is highly experimental. I hope he continues to perfect it.

FYI - When they use seeds for salvage, they usually use it focally (sometimes hemi-gland) so the radiation exposure to organs at risk is minimized. HDR brachy has been used focally or whole gland. Interestingly, when SBRT has been used for salvage, they re-treat the whole gland because the dose to nearby organs is so low. But only a couple of doctors are doing it. It might be a good idea to use a rectal spacer with re-irradiation. MSKCC (Drs. Scardino & Eastham) specializes in salvage surgery after radiation and get good results.

Your naturopath is probably not aware that radiation stimulates T-cell production, as does ablation. Any therapy that destroys cancer cells and throws pieces of cells into the serum will have this effect. When the T-cells detect the cancer antigens, it activates killer T cells that look for those cancer antigens elsewhere. When they are found, they are destroyed. This is called the "abscopal effect." It explains why remote cancers are sometimes destroyed by local treatment.

- Allen

It looks interesting - I'll try to get to it later. IMRT failure is local a majority of the time - another reason that I believe conventional IMRT is outmoded. Hypofractionation, and higher biologically effective doses than are typically given with conventional IMRT, seem to be a lot better at killing off radioresistant types. You may be interested in the following:

Site of cancer recurrence after first-line (primary) radiation therapy