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What makes me unique? I had full prostate ablation done with Tulsa in Jan 2025, not too many in that group. Add to that my psa rising from .7 to .9 to 2.9 then slowing to 3.0 over the 1st. year post procedure. Now to put me in obscure category, I also started taking Propecia (Finasteride) for hair loss mid 2025 which I've come to discover just recently, slows PSA expression from benign prostate cells but not from cancer cells. This makes normally difficult to interpret PSA levels for post full ablation via Tulsa super unreliable. I've stopped using Propecia (goodbye hair), but in can take several months for the PSA effects to clear. Fortunately, I have a great physician who has been monitoring my case closely and has me scheduled for a 4th MRI post Tulsa (nothing concerning found yet) and a PSMA Petscan. I'm hoping, but not very optimistic, that they show that I'm still clear.
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Good luck. Here is some more information on focal therapy.
At the 11/1/2025 PCRI conference the following was said by Matthew R. Cooperberg, MD, MPH
What about focal therapy?
* The energy modality matters much less than the accuracy of the imaging - which is not there yet.
* Overall focal therapy is associated with minor side effects, but high rates of recurrence both in- and out-of-field.
* Focal therapy is not really a replacement for surgery or radiation; it is better considered an adjunct to active surveillance
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4 ReactionsI wouldn't expect anything else from a surgeon. He is well respected in his field, but surgery would have been my last choice. I know some guys have had great outcomes with surgery, but the odds are not as good when it comes to side effects with surgery compared to Tulsa. I'm super happy that I chose Tulsa, and if I need a salvage treatment I'm ok with that as long as it's not surgery. As I hoped and expected, I have had zero side effects, but "possible" recurrence.
When it comes to recurrence, these are the stats I found.
Surgery - 80 to 90% cancer free 10 years
Radiation - 70 -90%
Tulsa - 70 - 85% (5 year, still new)
But look up odds of side effects and you'll see why I chose Tulsa. Erectile problem up to 50% with both radiation and surgery. Up to 20% Tulsa. Urinary tract complications are less likely with Tulsa too. Everyone has to decide what is most important to them. Quality of life was my main driver.
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2 Reactions@paulcalif
I’m with you Paul! I did my Tulsa in July of 2024. PSA has remained stable at 0.8. And 3 clear MRIs. I am perfectly OK with the fact that I may have just kicked radiation or something else down the road a bit. I was continent the day the catheter was removed and back to sex the same week.
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4 Reactions@paulcalif You seem to be totally in the know about your focal therapy and the possibility of a negative outcome. You chose it for quality of life issues and I can’t blame you - surgery sucks.
But if your cancer is truly back and you really want to kill it once and for all, ADT will probably be suggested as part of your treatment and QoL issues will once again, have to be addressed.
Please keep an open mind before you say NO! To ADT. If your cancer came back, even if it wasn’t considered high grade or aggressive before, it could be now.
Radiation alone may not be sufficient to put it down and ADT can certainly help achieve that. You will hear and read that ADT will give you an extra 3-5% chance to avoid yet another recurrence, but don’t hold hard and fast to that. This is a MoFo of a disease and it never shows its true colors. A wise Urologist once said to me “Six months of Orgovyx isn’t gonna kill you” - and he was right…Best,
Phil
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5 ReactionsI haven't researched hormonal therapy but I certainly will if it's recommended. Thanks for the advice.
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