pdcar 4756 I'm glad to share my thoughts because reading others' opinions have been so helpful to me! I always want to remind others that I am a PCa patient working through my own options. I'm not a doctor who specializes in treating prostate cancer.

-PCa SURVEILLANCE AFTER ABLATION THERAPY: My understanding is that there are two significant differences between post treatment RP and RT surveillance criteria compared to post treatment TULSA partial gland ablation treatment surveillance criteria. The first, and most important, is there is much less post-treatment surveillance data for post-treatment Tulsa partial gland therapy. The longest surveillance data I've seen for Tulsa was for a moderate sized study (115 men) at 5 years presented as an abstract at the 2024 annual conference of the American Urological Association and published in Journal of Vascular and Interventional Radiology. Most (if not all) of us who are interested in TULSA have a prospective life span of longer than 10 years. So we are interested in longer-term surveillance data with a higher level of evidence than a 5-year study of 115. There are hundreds of studies published in peer-reviewed journals detailing post-treatment surveillance of RP and RT that have followed patient populations totaling tens of thousands. The second difference in post treatment surveillance after partial gland ablation is the factors used to determine treatment failure/biochemical recurrance (BCR), at least at an early stage, do not seem to be as certain as they are in surveilling RP and RT after treatment. After RP or RT, an indication of treatment failure seems to be ether a 3 consecutive prostate-specific antigen (PSA) increases of more than 0.5 ng/mL or a .2 ng/mL rise above the nadir PSA, (usually below .1 ng/ml). This would be followed by a mpMRI and a guided fusion biopsy if lesions were detected. The best data I could find for detection of treatment failure after partial gland ablation therapy comes from cryo-ablation studies. Because the therapy is partial gland, there is no set guideline for PSA nadir after treatment. There is still some prostate gland left producing PSA. There also don't appear to be any firm guidelines on thresholds of PSA level or PSA rise velocity that might indicate treatment failure/BCR. Also, apparently there is some scarring that occurs from the ablation that may make definitive reading of mpMRI more difficult. The standard follow-up surveillance in the cryo-ablation studies was an annual random needle biopsy. This may have been because they were studies and they were searching for correlating surveillance diagnostic criteria that were less invasive. Two cryo-ablation studies I reviewed did have treatment failures with sub 4 PSAs, with what I considered to be minimal increases in PSA, and were not visible on the MRI, but were picked-up with the random needle biopsy.

-PATIENT UNDERSTANDING/ACCEPTANCE THAT BIOCHEMICAL REOCCURRENCE MAY OCCUR AND MAY RESULT IN AN UPGRADING OF PCa Dx & Tx. This caution really accompanies all prostate cancer treatment. In my mind it is probably very relevant to partial gland treatment because there is prostate tissue that remains that may at some time grow a new prostate cancer. The studies I've read on partial gland treatment show that the median time from treatment to an upgrade in PCa diagnosis (getting worse) is longer than for Active Surveillance patients, but shorter than for RP and RT patients.

All this said, I will remind you of something that I think jcf58 said (paraphrasing because I can't find the direct quote): He was comfortable going with TULSA because it was less invasive, had less toxic side effects, and advances in PCa treatment are accelerating so that if he needs re-treatment, there is the real possibility that future treatment will be more successful with fewer side effects. If I had been a good candidate for TULSA, that is exactly how I felt. Of course, I'm interested in others input!

I hope this helps! You have my sincere best wishes!