Cryoablation

I know that the most serious SEs that can occur after salvage cryo are urethral stricture and fistula. Incontinence and ED are also possible. We'll have to see after the catheter is gone. Didn't Gary Onik give you a written list of possible SEs? If he didn't, please slap his wrist for me.

I hope too that he gave you a monitoring plan. That would hopefully include a standardized questionnaire for evaluating urinary and sexual function, and a schedule for filling it out (including a baseline measure). I hope there's periodic PSAs and maybe a follow-up biopsy down the road.

- Allen

Stay Tuned-

I'll answer what I can. As you can tell from the poster's name, he was looking a recurrent cancer after IMRT failure (his treatment/PSA history is in his signature). His PSA rose above 2.0 over his nadir PSA, which is the signal for biochemical recurrence after radiation. It was then confirmed as a clinical failure by biopsy. (He probably also had a bone scan/CT to check for distant mets).

He said that 30% of his prostate was cryo-ablated. So this is focal (=less than whole gland), salvage ablation.

First of all, IMRT for low risk PC seldom fails - 95% have no recurrence (about the same for surgery and other kinds of radiation). Sometimes when there is a large tumor, it gets protected by a low blood supply (called hypoxia) from radiation damage. Or it may have had stem cells or other genotype that was peculiarly radioresistant. I also don't know how many grays they used. IMRT these days is about 79-81 Gy, which is about as high as you'd want it to prevent excess toxicity. (HDR brachy and SBRT use a nifty trick to get around that limit, and local failures seem to be lower.) That depends on having the right equipment to safely deliver doses like that. In a recent study of IMRT failures, about half were local only, and therefore potentially amenable to salvage therapy.

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

The catheter protects the urethra during treatment and helps prevent strictures. A lot depends on where the focal treatment is. The catheter allows the urethra to heal without swelling shut. Some focal treatments are ruled out entirely if they are too close to the urethra, bladder neck, or rectum. Heat (or cold) travels and can do damage outside of the treatment zone. That's true of all forms of thermal ablation (e.g., laser, HIFU, cryo, PDT, RF).

RecurrentPB......with the catheter still in I am sure nothing feels or looks positive.
BUT you had as extensive of a biopsy as one can have and only 4 of 4 cores were cancerous and Gleason 6's at that.
You then had them ablated by a well known Doc.
If I were you I would probably go forward and forget about PCA.
You are Cancer Free.
Do let us know about your urinary results post Cath.removal.
Of all the focal therapies cryosurgery seems to require the longest catheterization . For those considering cryosurgery as a primary treatment it is good to know the post treatment affect on the urinary tract.
And Congratulations!