Pros & cons of brachytherapy, HIFU, Tulsa treatment options?

Tulsa uses the same high intensity ultrasound that HIFU does, but it is much more precise. You are in an MRI machine during the entire process, and that ensures that the target area is completely ablated with the proper margins and is heated to the required temperatures.
I liked the technology, low risk of side effects, the fact that all other options are still available if needed later, and the early promising results.

@jcf58
Thank you sir, good luck and prayers to you in this adventure we are all experiencing.

PHOTON: Gamma radiation

External beam Radiotherapy:
5 visits [SBRT] Prostate size < 100cc on MRI or after Adrenergic Deprivation Therapy: Pill: Orgovyx (relugolix)
20+ (IMRT MFRT]
30+ (IMRT CFRT

Brachytherapy:
Interstitial Radiotherapy [LDR/'Low dose']
Seeds, 1 20 minute procedure, optimal dose which takes weeks/months....seeds remain inertt afterwards
High dose Radiotherapy [HDR/]

PROTON ( Neutrons ? )

Brachytherapy is very effective, The other treatments work but long-term results are not really known.

Here’s what one of the doctors at the PCRI conference had to say about focal therapy, Which includes HIFU and TULSA pro.

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

@jeffmarc I think it is important that patients understand that the imaging problem mentioned by Dr. Cooperberg is related to the fact that even when an MRI machine is used during a focal treatment procedure, the focal treatment process cannot see all the cancer cells that need to be ablated. Even high quality 3T MRI scans routinely miss "invisible" cancer cells. These are typically 3+3 and 3+4 cell groupings that have not grown dense enough to appear different from healthy cells in an MRI scan. As such, focal treatments nearly always leave some cancer behind because the doctors can't see all the cancer that needs to be destroyed. The cancer left behind may ultimately grow and escape the gland before it can be seen later in a more advanced stage by either MRI imaging or a PSMA PET scan. And thus, it is not a safe situation to say, oh well, we will just do another focal procedure later on if need be. This is why Dr. Cooperberg says focal treatments are best considered to be only an adjunct to active surveillance.

A primary radiation treatment gets around the invisibility issue of some cancer cells because it treats the entire gland and even the wider pelvic region if necessary. Of course, in that approach, healthy tissue is exposed to radiation but the dosages are designed to be something the healthy tissues can tolerate while killing both the seen and unseen cancer cells.

I did hemi gland Tulsa Pro in Dec at Mayo Jacksonville and tolerated it well without any side effects. Several things led me to this procedure. One was the location of the tumor which was internal to my prostate (closer to the urethra). The other was it was confined. Another was I was having urinary issues (weak stream) due to the location of the tumor to the urethra, and the last was a Prostox test showed I would have a high chance of urinary toxicity if I did SBRT. All these let me to do Tulsa Pro where they ablated the front half of my prostate from 9 to 3 o'clock. After a short period I was urinating much better, and feeling great with zero ED issues. I am 62 years old, good health, active, did not have enlarged prostate, with PSA of 4.5, and biopsy 1 core out of 13 with 70% abnormal and only 10% of that 70% a 4 (3+4=7). All in all I am happy with my choice but I go back March 26th for my first PSA after the procedure. Hoping to see a 50% or ore reduction.

@harryo54, what did you decide? What helped you in your decision making?