Recurrence after Tulsa full ablation.

Posted by paulcalif @paulcalif, 5 days ago

I'm 14 months post Tulsa full ablation. I can't predict for 100% certainty yet, but I'm running out of possible explanations for my rising psa levels. Last week I had an MRI then a PSMA Petscan. The MRI results came in first, all clear, but then the Petscan showed probable cancer in 2 areas. 70 to 80% chance according to Chat gpt's review of the report. I meet with the radiologist on Tuesday. At least it's still contained in my prostate. "IF" Tulsa is an option for salvage I'll probably choose that again over radiation even though the odds of getting all of it with radiation are better, It's the side effects that I don't want to be burdened with. Doctor will almost certainly send me to a urologist for a new biopsy. Bummer.

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topf | @topf | 5 days ago

What was your Gleason score and Decipher that you chose whole gland Tulsa? Surgery is difficult after any whole gland treatment. Have to brought up HD Brachytherapy as a definitive treatment option?

Jeff Marchi | @jeffmarc | 5 days ago

I suppose only part of your prostate was treated by Tulsa PRO, Otherwise, they wouldn’t consider doing a biopsy. Some people in this forum have had success for a significant amount of time with Tulsa PRO, But long-term results of focal therapy are unknown.

At the 11/1/2025 PCRI conference the following was said by Matthew R. Cooperberg, MD, MPH Urologic Oncologist UCSF

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

bjroc | @bjroc | 5 days ago

You probably have what I have, which is on the opposite pole of where they are ablating the prostate tissue compresses, then it takes time to rebound but they can't ablate it really since it is pressed up against the prostate capsule apparently. So I am in same boat. Pre-procedure my doctor wanted to ablate roughly 75% so he said, verbally he told me he got 2/3 or something post procedure, but all the imaging shows at most 40% was taken out.

This is a new issue with Tulsa, docs would be smart to hear what is going on, that is the tissue during procedure presses up to the wall and doesn't get ablated. Usually on opposite wall but some might happen anywhere since they are pushing probes and all kinds of things around and the tissue doesn't just spring back.

I am looking at all kinds of treatments now. They will tell you head to salvage radiation, or so they call it. Not all radiation is the same. I wanted Tulsa again, but doc just wanted to wash me away I guess.

I had biospy initial report said 4+3, now downgraded by my university to 3+4. They will want biopsy on you.

Tulsa Pro is still sort of "buggy", many issues to work out obviously.

paulcalif | @paulcalif | 5 days ago

Sorry to hear that you're in the same situation. I hadn't heard about the tissue being compressed as you describe but makes sense. Let us know what treatment you decide to go with and best of luck.