For the record, I’m a fellow prostate cancer patient and not a doctor so I’m not giving medical advice; just sharing information.

I looked into Tulsa Pro as well when I was seeking treatment, and I was not a candidate, probably for the same reasons that you might not be a candidate.

The following is an excerpt from the Tulsa pro website:

“Who qualifies for TULSA-PRO?
Whether a patient qualifies for the TULSA procedure will be determined by the treating physician on a case by case basis. In general, patients should have low to intermediate risk disease which is confined to the prostate. Generally, the patient should have a PSA of less than 20. If a patient has significant calcifications within the prostate (as determined by a CT scan), then they are not a candidate for TULSA, because the calcifications will block sound waves…”

If you look up Gleason scores for prostate cancer, Gleason seven,p (4+3 specifically) is considered unfavorable intermediate risk and with your PSA being 22 it sounds like Tulsa Pro would not be a preferred treatment to elicit a cure and stop the cancer from recurring.

I’m no medical expert on cancer, but I was a regular attendee at a local prostate cancer men’s support group in Chicago. What I learned there just a couple years ago was that some doctors might consider 3+4 Gleason seven patients for active surveillance, none would consider 4+3 Gleason seven prostate cancer patients for active surveillance and I doubt anyone would consider you for focal therapy. As I understand it, 4+3 left alone can become 4 +4 and spread beyond the prostate and then you could be in the fight of your life. Take it from someone who knows. I had what should’ve been considered low risk Gleason 6 3+3 cancer. I received focal therapy which failed and now the cancer has spread beyond the prostate, and life is a lot more challenging.

I understand that you don’t want surgery or radiation. I get that. I didn’t want that either. Unfortunately I’ve had to have both plus hormone therapy which has affected my quality of life; all because my cancer spread beyond the prostate. Prostatectomy or radiation therapies practiced by highly skilled physicians and centers of excellence are likely your best choices for eliciting a permanent cure.

There is an excellent book called “surviving prostate cancer” by Dr. Patrick Walsh. I suggest you consider buying a copy. Do not buy the fourth edition though; purchase the current fifth edition. You’ll get far better up-to-date information regarding your options in by reading that book written by some of the best practitioners in the field then you will on this forum.

Good luck on your journey. Let us know if we can answer anything else for you.

If you were seeing a urologist, they are surgeons so they want to do surgery. My brother was in the same situation you are right now and he had five sessions of SBRT radiation (cyberknife) at UCSF and it worked great.

If you have had a PSMA pet scan and the cancer has not spread past the prostate then that is a really good option for you, get an appointment with a radiation oncologist to see what they think. If you have surgery, you probably will not be able to get an erection unless you have nerve sparing, and it is successful, but if you have radiation, you usually will still be able to get an erection.

Even after surgery if you get Trimix injections within a few months of surgery, you probably can get an erection again. If you wait too long, it may not work.

You should get genetic testing to see if you have a genetic anomaly.

wyoming please consider the Mridian Linac with a built in MRI. Real time viewing and treatment. What the RO sees on the MRI in real time is what they treat. Less exposure of healthy tissue which impacts side effects and toxicity. I had 5 treatments in February 2023. Last PSA was .75 down from 10. Google the Mirage study. You will be glad you checked this out. Good luck.