Focal Cryotherapy vs RARP

Additional information would be helpful towards providing you with better input.

Gleason 3+4 or 4+3? How many cores with any 4? Decipher score results? MRI or other scan results?

Here's more info...Gleason 3+4, four cores with 4, PI- RADS 4 PI-n MRI, no Decipher test

Although I like the idea of focal cryotherapy, four cores of ‘4’ is pretty substantial - and those scores are just from the targeted cores.
Also, the percentages of abnormal cells is also a factor. A higher number could indicate more neoplastic tissue present in the rest of the gland.
I only know one person who had cryotherapy and it was done by a surgeon on Long Island, NY who was a loud advocate for the procedure. It did not turn out well for him and his cancer became oligometastatic.
Of course, this is only ONE case and there are probably many successes. Your surgeon is correct, however, in that cryotherapy usually requires more procedures in the future. Best of luck on your decision.
Phil

Tulsa
https://tulsaprocedure.com/find-a-tulsa-pro-center/
https://tulsaprocedure.com/
If wondering about Tulsa Pro from a science point of view, here is a basic Tulsa science overview article
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9231661/
Conclusions:
“As an alternative to conventional treatments, TULSA is safe and effective for prostate tissue ablation in men with primary PCa. There is also evidence that TULSA delivers effective relief of urinary symptoms while treating PCa in a single, low-morbidity procedure. The likelihood of freedom from additional treatment or potency preservation is associated with the planned ablation fraction.”

Thanks Phil. I asked my surgeon about the number of cores with Gleason 4 cells. He said that all four came from the same target lesion so probably just a sampling thing not an indication of spread throughout the prostate because all the random cores were negative. They said, he still could not guarantee that there were not other cancer cells outside the target lesion. This the reason for lower long term success rates with focal therapies. He used to be at NYU and said that focal cryotherapy was popular with wealthy men who wanted to minimize erection and incontinence side effects. The research on it's long term effectiveness is lacking.

Thanks for sharing. I'm familiar with TULSA - Pro. Cryotherapy is approved by insurance but I don't think TULSA is. And the closest person to me who does this is a long way away. I'm at a university center of excellence with very knowledgeable and experienced doctors and trust them.

I think he’s being honest with you - there are no guarantees until they analyze the whole gland after removal (unfortunately!).
Phil

I've heard of so many stories of post surgery pathology showing greater volume of disease and higher Gleason grade and I think the literature bears this out.

Just wanted to say that we were informed that TULSA can be successful only if cancer is close to urethra, not if it is on outer edges of prostate.

Also, we were informed that any localized therapy is almost never curative, it just removes cancer from that particular part of prostate gland and one has to continue with AS, inclooding having biopsy every year or two. But, it can be a valid choice if somebody knows all of the risks and details and still can not imagine doing RP or RT at this point.

My lesion is near the prostate capsule. Interestingly, my surgeon said that cryo is not good for lesions near the urethra because of potential damage.