Tulsa Pro Experience, Mayo Clinic MN – July 2024

I only had 30% of my prostate ablated. I walked out of Mayo at 12:30 pm and walked 3 blocks to my car. I felt like I could have driven home. Went for a 2 mile walk the next morning. My recovery may not be the norm though.

Will I feel like flying home later the same day or next day? I have to fly into town the day before for treatment. Then I have treatment at 8am. I'll have a catheter for a few days. Will I feel like flying home later that day? Or the next day. Thanks folks.

Mine was covered under Medicare in 2024 (had to be done in a hospital— I did Mayo Rochester).

What did it cost and does Medicare now cover

I had TULSA done at 68 years of age. Total gland ablation was performed for a 3+3 Gleason, with nine out of 30 cores positive for cancer. At 3 months post-TULSA, my PSA was 0.10, and my MRI results at 6 months ( see above ) show no cancer. My PSMA before TULSA showed no uptake, not even in the prostate, though the biopsy indicated cancer. I had two tumors and some mild BPH. It looks like TULSA resolved all of those issues.

Post-TULSA experience was zero pain, seriously, zero pain from the treatment. I had two medications for bladder spasm and the feeling that I sometimes needed to pee. I rarely took those for the 12 days I had a catheter.

You can have your prostate removed, and still have a chance of cancer returning. I looked for a procedure that was minimally invasive, low pain, quick recovery, did not limit any future treatment that hopefully I would not need, and did not require me to have the prostate removed. TULSA was the answer for me. At 6 months, I appear to be cancer-free. I will see what my URO wants to do, maybe another MRI at 1 year post-TULSA. I'm not sure what he will want to do, but right now I am delighted and grateful.

Here is my 6-month post-TULSA MRI W/WO contrast. I deleted the non-prostate findings. PSA at 3 months post-TULSA was 0.10. Looks like TULSA was a success for me.

I did the total gland ablation as there was no sense in a focal ablation that would have almost been a guarantee to return at some time in the future for further treatments. I wanted this taken care of now, and to be done with it.

Healing has taken longer than I hoped. Only now has my stream really improved to what I would consider normal. My Testosterone is low-normal, so I have no sex drive and very mild ED. All in all, at 69 years of age, I think I don't even care about that at all.

FINDINGS:

Localizer/T2 coronal: No acute abnormality.

Prostate: Post ablation changes of the peripheral zone of gland. Residual
transition zone is measuring 3.0 x 2.8 x 2.6 cm = 11.4 ml. No findings of
high-grade tumor.

IMPRESSION:
1. Post ablation changes of peripheral zone of prostate gland. No
recurrent disease or findings of new high-grade tumor. No pelvic
lymphadenopathy.

My Mayo Doctor told me all options are on the table if it returns. Really depends on how and where it comes back.

Normally, what you would do is radiation. The question is what does the PSMA PET scan show. Does it find any metastasis if so, they can be radiated with SBRT normally. If nothing can be found, they might want to radiate the prostate bed and the lymph nodes. This type of radiation usually works for a few years at least.

Another option is you just can wait until something pops up and then zap it. Some doctors believe in that strongly.

It’s the focal treatment concentrated on the prostate then it’s not there to do surgery on or have continued spread from that spot. It’s more likely that mini metastasis got away before the focal therapy was done, Could not be seen so they could not be treated.

One other question regarding TULSA. If cancer does return what do we do? Also is monitoring possible?

More focal?
Whole gland treatment?
(Essentially like a Rad. pros. ?)
Radiation?
Da Vinci Rad Prosectomy? (Sounds iffy)

Appreciate your input.

Thanks so much.