Irreversible electroporation (IRE)

Hi, Mauk, I don't know if the five fraction MRI guided radiation would be right for you. It seems like a really good option that you might check out. https://www.youtube.com/watch?v=MbnE291POwk Best luck.

I agree with @gently At least look into a built in mri radiation machine i.e. MRIdian or the Elekta Unity

I think you’ll find few (in the U.S.) that have had Irreversible electroporation (NanoKnife) for prostate cancer, because it doesn’t have FDA-approval for that purpose.
However, it does have “FDA clearance” for soft tissue ablation, including use in the prostate. You’ll have to see if that designation makes a difference with your doctor and insurance company as it relates to treating your prostate cancer.

Most people if HIFU isn't the option for them, Tulsa pro is next option and a much more comprehensive option that isn't so limited in numbers of people who qualify. IRE sounds ok if done really well is all I know, when I was looking a few years ago I couldn't find much on it or which places did it really well because that is really important. Good luck, it is a complex time when picking through all the info out there.

I did Tulsa Pro for my 4+3 last July at Mayo Rochester. I too was not eligible for HIFU due to location. I am glad that I was not eligible as Tulsa is much more precise. I am one year out and no sign of cancer. Medicare paid for the procedure.

If I had 3+4, relatively low PSA and very low Decipher, I would do nothing but monitor until it progressed. You may not ever have to do anything.

my PSMA shows an ECE, all the rest is clear, bones, brain, heart, etc...no major health issues. Should I be CONCERNED of the ECE...I was recommended surgery/radiation. I am opting for Radiation as follows
MR_LINAC
Cyberknife
Brachytherapy HDF

Any suggestions

ECE is very concerning and suggests (as the name is saying) that cancer breached prostate membrane and is now outside of the gland. It is an adverse prognostic factor and I would not wait with treatment, whichever you choose (RT or RP with possible adjuvant therapy). It will also depend of your age and general health status.

I would seriously consider PROTON radiation. I had proton and dual tumors along with the prostate we’re completely destroyed as evidenced on PSMA/PET. No side effects except for some frequent urination, may or may not be attributable to the protons. Also theoretically it spares healthy tissue. I was Gleason 8 4+4 in one area.