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How does TULSA Pro compare to SBRT?

Posted by N227 @n227rv, Sep 2 12:10pm

74 year old with 3+4=7 Gleason. I have been reading about the TULSA Procedure and wondered what experience others might have had with it. I am considering SBRT at Memorial Sloan Kettering, but am not sure about how much of the radiation hits the "bad guy" in my prostate - said to be "1.1 cm right posterior base to mid gland peripheral zone lesion" and how much irradiates the entire gland. In the same vein, though, I don't see how TULSA can target part of the prostate without harming the entire gland and surrounding tissue. That "surrounding tissue" is essential to my quality of life!

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

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K. J. HOLZ | @kjholz | Sep 4 11:21am
In reply to @n227rv "@kjholz ... Good to know. I'd like to read more. Where did you get info about..." + (show)
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@kjholz ... Good to know. I'd like to read more. Where did you get info about the clinical trial(s) for TULSA?

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@n227rv

"Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation of Prostate Cancer" Journal of Urology 2021. Klotz et al
https://pubmed.ncbi.nlm.nih.gov/33021440/
And here's the video presentation "MRI-guided Transurethral Ultrasound Ablation (TULSA) for Prostate Cancer" Laurence Klotz, MD, FRCSC presentation December 11, 2021.
https://grandroundsinurology.com/mri-guided-transurethral-ultrasound-ablation-tulsa-for-prostate-cancer/
Note that as a result of the TACT trial, "modern protocols utilize thermal dose escalation (delivering higher, more consistent heat over 55°C to the tumor margin)" and "instead of a blanket 3 mm buffer everywhere, surgeons use the system's 1 mm precision to custom-contour the boundary." --Source: AI Gemini.

The current, ongoing study is the CAPTAIN trial.

I suggest you try AI and ask questions there. Be careful because I've been given incorrect leads/advice. (My wording was often the problem...) I mainly used Gemini and ChatGPT.

Also just a heads-up. Stick with researchers/centers of excellence sites. You'll recognize the Tulsa Pro "evangelicals" and patient testimonials.

My wish for you is whatever you decide, you'll be good with that choice! Cheers.

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bjroc | @bjroc | Sep 5 6:24am
In reply to @n227rv "I got interested in TULSA after reading Jeff Marchi's comment, “Normally, when somebody has SBRT radiation..." + (show)
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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?

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@n227rv As I mentioned earlier, I had Tulsa. Where the tulsa ablation was stopped, apparently because my colon comes up to the prostate, that is where I had a recurrence. At Mayo they just inject a spacer to push the colon away and they used cryoablation to finish things off (hopefully for good). So two procedure person here. That is one thing I wasn't told about in Tulsa prep that sometimes they don't want to get near things like the colon coming right up to the prostate but they did they best they could on first run with Tulsa. I got it now with cryo, despite that earlier limitation that stopped doc from doing as good a job originally. So far I am getting on 6 years into this, and hopefully don't need anything more.

I will add the reason Mayo didn't repeat Tulsa a second time for me was because they feel cryoablation when done the same way under MRI provides a little more power to the target to destroy it. So for me the second time was cryo. The procedures are nearly identical.

All is good so far now for me, one month out from second run (1 Tulsa 2 Cryo).

Good luck with the choices, it is complex.

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