Recurrence post Tulsa Pro

Looks like you have run into what Dr. Cooperberg Had to say about focal therapy.

At the 11/1/2025 PCRI conference the following was said by Matthew R. Cooperberg, MD, MPH Urologic Oncologist UCSF

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

You have put on a list of a whole bunch of different treatment techniques. You really have given no information about what your preferred next treatment would be. There are a lot of options. SBRT radiation with a proton machine would Keep your sexual function for a while, But any radiation can burn up the nerves that you can get spared when doing surgery. For some people that means the loss of the ability to get an erection over time. The thing is there are solutions for that, The implant is very popular and works quite well to continue getting a good erection.

You could go focal again, It might take care of it.

Your PSA jumping to 7 does say you need to do something. As you know, your BPH problem could be solved by surgery, But that has a lot of other issues, can they spare the nerves for example?

Too many options, What do your doctors have to say? Are you willing to go anywhere to get the treatment you want?

@jeffmarc

Thanks for followup.

As mentioned somewhere in there I was turned away for further Tulsa Pro, mentioned reason was scar tissue + cavity area created by first tulsa pro and concerns that energy would get deflected from the scar tissue and cavity area. So no luck so far on tulsa repeat.

My next preferences are the either brachytherapy alone, or, proton SBRT which I call either of the Varian Probeam (and similars like Mevion I think it is called) or of course regular proton like Hitachi which is a larger scale proton system compared to the Probeam. I was in line in 2023 for Proton at Mayo Rochester, but after two months they said no slots available for foreseeable future. I think they bought the Probeam in Rochester since, but not sure. I got Tulsa Pro in FL when they had no slots on proton machine, anyway my prostate is smaller now so that is good.

I am looking all over, so much willing to travel and have done lots of travel for care already. I live in West NY, but have been at Mayo Rochester and had Tulsa in Florida.

As of late yesterday afternoon I have now lined up in next three weeks a talk to a brachytherapy doc, and a place that does proton. I will have to see how it goes, but it takes time and lots of record sending for sure.

@bjroc sort of a uneducated bystander except I had PC with removal. I made the decision with NSLARP and I had maintain sexual function at the top. At 68 it was still working fine. As a Male not ready to give it up. Married 48 years. I agree with Jeff there are options. Not necessarily spontaneous ones. PC is a shot to your manhood no matter what you pick. I would leave sexual function at the top but rethink being able to shuffle it around.

@tuckerp

Thanks, yes I don't think my titles are exactly meaningful universally, however the list is pretty good as a set of groups that I think really does follow a path for many or even most purposes. Sure people can make millions in the lottery for example, but you wouldn't want to call buying lots of lottery tickets investments to make millions. Yes some people win, but that is not really most.

So yes there was a real lot that went into my list. I am currently at that Brachy, proton area in my appointments. I don't think there are changes in my list as an order to go down here, but I agree as a simple list it doesn't impart all the meaning because there are subgroupings there. Plus the effects of ADT are hard to incorporate as a simple list with stats behind it, so it does take a lot of extra reading to understand the subgroupings and arrangements, plus willingness to not be too strict about the words and titles. I don't see any re-groupings as a simple list I could post however on paper I can circle and make subgroupings that are easier to put together. At this point if I can get Brachy or proton without ADT it would be pretty beneficial to me. At same time if 5 years ago there had been more work in the focal world it might have been easier to clear up my issues when they first started so I don't have to do so much today. Lack of development of that area back then has been hard for me today. Clearly the prostate medical world has been too far on the one end of the list to benefit many or most, it benefits a lot to emphasize the end of that list but that isn't a very good setup basically. Making for over-treatment and so on being the theme of how most patient visits end up. True my list isn't perfect as a simple list, but the prostate medical world is pretty mixed up (sort of far right style or themed almost, maybe again poor words but just words again). I have to have something to go on too and that is why I made that list for myself and anyone else if they are in same area.

@bjroc
I was interested in MRidian Viewray , than read they were Bankrupt, since read there are quite a few active machines still working. For the radiation path the margins are the best. The Phase III Mirage trial had some convincing numbers. Maybe Jeff or others could comment on what they know about the advantages for you would be.

@dribbles
While the MRIdian was unsupported for a while, it has been taken over by a new company and is back in full operation.

Following a voluntary Chapter 11 bankruptcy filing in July 2023, the assets of ViewRay, Inc. were acquired to form ViewRay Systems, Inc., which currently manages the MRIdian technology. This new entity designs, manufactures, and markets the MRIdian A3i MRI-guided radiation therapy system.

Thanks for the info Gentleman. Keep it rolling. I'm having my post Tulsa, 6 mo recheck at Minn/Mayo May 5th. Good thoughts. Thank you for continuing info, Winners!

@bjroc you have done a nice job thinking it through. This is where it starts. good luck.

When I was confronted with a similar treatment decision, here’s what I did —>

One of the understandings I had with my doctors was that quality-of-life and successful treatment were equal priority for me. The ultimate decision came down to side-effects and quality-of-life (and what insurance would pay for, of course).

With every other major decision in my life where I have the time to decide - buying a house, a car, choosing a career, going on vacation, etc. - I make a list of what I want and what I don’t want. With all other factors being statistically equivalent, this decision for prostate cancer treatment was no different than any other major life decision.

(As a retired computer engineer, everything comes down to a spreadsheet…..) So, I put together a spreadsheet and listed across all treatment options that I had thoroughly looked into. Then listed down all possible & possibilities (%) of side-effects from each type of treatment, and gave each one a score. The one with the lowest total “score” ranked highest. I then took that list, and narrowed it down based on the prevention and cautionary activities available related to each individual type of treatment.

I then “scored” the quality of life priorities that came out of my introspection, and compared that final score result with the treatment options score result.

The score that was closest matching was my 1st choice, 2nd closest was my 2nd choice, etc. For me, Proton ranked at the top.

I hope you can find a viable pathway to your decision.