@ucfron Hi WingNut. Please provide the source for your statement: "Tulsa also reduces the chance of spread since it stops blood flow in the area by ablating the blood vessels."

The reason I ask is because I typed your statement into AI (Genesis) and got:

"The claim made by that individual is partially true in its description of how the technology destroys tissue, but scientifically incorrect regarding its impact on cancer spreading. [1]
The TULSA procedure (Transurethral Ultrasound Ablation) does indeed eliminate cancer by cutting off tissue activity, but it does not completely eliminate the risk of metastasis (spreading). [1]
Here is a detailed breakdown of what is accurate and what is misleading in that statement:
What Is Accurate: The Destruction of Blood Flow
The individual is correct that TULSA kills the blood supply to the targeted area. [1]
• Thermal Coagulation: TULSA uses high-intensity ultrasound waves to heat the targeted prostate tissue to 50–60°C (120–140°F).
• Vascular Occlusion: This extreme heat cooks the tissue (ablation) and instantly clots the micro-blood vessels feeding the tumor. Without blood flow, the localized tumor cells die rapidly. [1, 2, 3]
What Is Inaccurate: "Zero Chance of Spreading"
The claim that this mechanism creates a "practically zero chance of spreading" is false and medically dangerous. [1]
• Localized Treatment Only: TULSA is a focal or whole-gland regional therapy. It only eliminates the blood vessels and cancer cells inside the targeted boundary of the prostate. [1, 2, 3]
• Micro-Metastasis: If any microscopic cancer cells mutated and escaped into the pelvic lymph nodes or the broader bloodstream before the procedure took place, cutting off blood flow to the primary prostate tumor will not stop those external cells from growing.
• Recurrence Rates: Clinical data shows that TULSA does not have a 100% cure rate. In major clinical trials, about 16% to 23% of patients experienced a local recurrence or required additional salvage therapy (like radiation or surgery) within 4 to 5 years. [1, 2, 3]
Who is TULSA actually for?

Because TULSA cannot stop cancer that has already begun to spread, it is exclusively approved for patients with localized, low-to-intermediate-risk prostate cancer (where the cancer is strictly confined inside the prostate gland). Its primary clinical advantage is not that it cures cancer better than traditional surgery, but that it causes significantly fewer side effects like erectile dysfunction or urinary incontinence. [1, 2, 3, 4]
If you are researching this for yourself or a loved one, let me know:
• What stage or Gleason score was diagnosed?
• Has a doctor recommended TULSA vs. traditional surgery or active surveillance?
I can provide specific comparative details on side effects and success rates."

Being a cautious type, I also asked ChatGPT:

"Short answer: No — the statement is not true. TULSA (Transurethral Ultrasound Ablation) does destroy targeted prostate tissue using heat, but there is no evidence that it “kills all blood flow to the tumor” or that this makes metastasis “practically zero chance.” TULSA is a local ablation therapy, not a systemic anti‑metastatic treatment....

Does TULSA “eliminate blood flow” to the tumor?
Ablation procedures (including TULSA) heat tissue enough to cause coagulative necrosis, which does disrupt microvasculature in the treated zone.
But:

No clinical source claims TULSA “kills all blood flow” to the tumor.

No evidence shows that TULSA’s vascular effects prevent metastasis.

The purpose of TULSA is local tumor destruction, not vascular shutdown....

Does TULSA make metastasis “practically zero chance”?
This is incorrect.

TULSA is only indicated for cancer that is already localized. It is not used to prevent spread in cancers that are already metastatic.

Clinical trials show good local cancer control, but not that it eliminates metastatic risk.

Long‑term data are still developing; TULSA does not replace standard systemic therapies for higher‑risk disease.

In other words: TULSA treats what is inside the prostate. It does not guarantee that cancer cannot spread...."

Finally as @bjroc has already discovered the statement "You can always get a second Tulsa procedure" is BS galloping. I've read of only two people and both had *partials* --one who is in the CAPTAIN trial and (if I read things right) needed a Tulsa redo a year after the procedure.

Last, I see you scored High Risk for Prostox SBRT but were ok for IMRT. Forgive me but I'm so envious of you....