How does TULSA Pro compare to SBRT?

I had Tulsa Pro a little over two years ago. Because it is done in an MRI it is very precise. They watch in real time what the temperature of the tissue is. I had 30% of my prostate ablated, and you can clearly see the definitive margins. My prostate size went from 45 cc to 30 cc. I had zero side effects and have no evidence of disease at this point. I was 4+3. Click on my profile and you can see my whole story.

I had Tulsa 3 years ago (Dr Scionti in FL), then just recently a recurrence in gland and this was handled by cryoablation at Mayo. These kind of procedures tulsa and cryo (the modern versions) are done while you are in an MRI machine. They can watch where the action in happening and turn things off or down if something bad is going to happen. Thus these are feedback mechanisms. As anyone who took engineering, we know a system with feedback is better than one without.

It is true sbrt they use imaging to check but mostly that is about positioning you before beaming. I didn't have sbrtt but some places seem like they are more on top of it, and some seems like they are maybe less careful. They can put in markers to help position of course. But this is not feedback really. The machines these days have fancy built in mechanisms to check where beaming, and in some cases it may work really well, but I hear not always. Hard to say.

Hi N227. Gleason 3+4=7 here. 1 cm lesion. Rt mid to apex PZ. My husband (turned 79 last week) had whole gland Tulsa Pro in early April.

Just to reassure "whole gland" means ablating as much as possible but sparing critical structures. From AI: "The TULSA-Pro system delivers a high spatial targeting and ablation precision of ±1 mm to destroy targeted prostate tissue while sparing critical surrounding structures."

Originally, my husband wanted SBRT. As a precaution we ordered the PROSTOX tests ("Ultra" for SBRT and "Standard" for CFRT/MHFRT). They are genetic biomarker tests designed to predict "risk of late urinary side effects (genitourinary or GU toxicity) following external beam radiation therapy."

He scored High Risk on both! So radiation was out for us. You can get PROSTOX results fast and that will assist you/team in your treatment decision.

One thing: whether you choose SBRT or Tulsa Pro, if you're like many, you'll be living 3 months at a time. That's true even for prostatectomy. From PSA test to PSA test.

Either way wishing you/Memorial Sloan Kettering all the best and cheers.

SBRT for prostate cancer typically targets the entire gland. Ask your RO what will be targeted. If they say it does not matter where the lesion is within the prostate it is because the whole gland gets the maximum dose.

Tulsa Pro delivers treatment through a catheter, so the urethra is at risk. If there is a single lesion or area where all the lesions are then that area can be targeted for ablation. If there is EPE it will not be done since the treatment is within the prostate capsule. Other focal treatments are Cyro, IRE, laser, and HIFU. All have the ability for partial treatment. All have higher recurrence rates if for no other reason than that most of the prostate is still there and could contain or develop prostate cancer.

@jim18 re "Tulsa Pro delivers treatment through a catheter, so the urethra is at risk."

Tulsa Pro doesn't "deliver treatment through a catheter" but rather through an ultrasound applicator (a very thin, rod-shaped "wand"). A catheter is only used *after* Tulsa Pro.

This wand-device has a built-in fluid cooling mechanism to shield the sensitive urethral wall from heat damage during the procedure.

[From AI: "Active Water Cooling: The transurethral applicator circulates fluid to keep the urethral wall at a safe, cool temperature while the ultrasound energy shoots outward past it to destroy the targeted prostate tissue."]

Many men choose Tulsa Pro because its coolant "inside out" delivery is designed to *protect* the urethra --to preserve urinary function. And of course Tulsa Pro's MRI precision guidance is key here.

How Does Tulsa-Pro for #ProstateCancer Work

Tulsa pro has not Had clinical trial number completely worked out yet.

Memorial Sloane Kettering has the Elekta unity Machine, which uses 3 mm margins exposure to healthy tissue after erradiating the entire prostate. Other forms of Radiation without the built-in Mri, use 3 to 5 mm margins. I was treated in February 2023 and so far so good.

@bens1 Hi. I certainly agree with your "Tulsa pro has not Had clinical trial number completely worked out yet". Tulsa Pro's first [TACT] trial had 115 participants with 43 men (37%) as Gleason 3+3's.

37% 3+3's... 🤷‍♀️

I got interested in TULSA after reading Jeff Marchi's comment, “Normally, when somebody has SBRT radiation their prostate is pretty much decimated only about 40% left and it’s a block of tissue not a prostate. … Normal SBRT dose is 74Gy to 80Gy during prostate cancer radiation to the prostate. That is a lifetime radiation amount for that spot.”

This is not the way SBRT is presented by the surgeons.

It appears that both prostatectomy and SBRT leave the patient, that is you and me, either without a prostate or with a chunk of leather where a working gland used to be - along with collateral damage to other tissue. I wonder if just the lesion(s) can be treated and, if the cancer comes back, a patient can deal with the new situation. I am fine if I buy five more years after a fairly non-invasive treatment. Who knows what innovations there might be in the treatment of prostate cancer in 2031?

@kjholz ... Good to know. I'd like to read more. Where did you get info about the clinical trial(s) for TULSA?

@n227rv Hi again. You wrote "It appears that both prostatectomy and SBRT leave the patient, that is you and me, either without a prostate or with a chunk of leather where a working gland used to be - along with collateral damage to other tissue" I would have qualified that to "potentially along with collateral damage to other tissue".

Here's the thing about Tulsa Pro you need to know. Whole gland ablation will shrink your prostate by 90% approx. We were told that my husband's 48 cc prostate (large apricot or a golf ball) would shrink to about 4-5 cc. (volume of a large grape or a single standard board game die).

Now most Tulsa Pro recurrences can go the radiation route. We can't --he scored "High Risk" on both PROSTOX tests.

So far, I know of two men who got recurrence and got it treated with a second Tulsa Pro. One had only Partial (75% approx) the first treatment. The second originally had a Whole gland procedure. But. No idea of the original size of that prostate...

Here's the point about Tulsa Pro and you nailed it. "I am fine if I buy five more years after a fairly non-invasive treatment." We would be so grateful for that happening to us.

And for the exact reason you raised "Who knows what innovations there might be in the treatment of prostate cancer in 2031?"

It's called Kicking the Can Down the Road.

We had no choice. PROSTOX slammed the door on any form of radiation. So we kicked the can down the road.

Wisest advice I ever received "Do Your Homework. Do Your Homework. Do Your Homework."

Cheers.