Tulsa Pro - share your experiences

How is it that you determined your BPH hasn't stopped?

Thanks for the interest.... It isn't too hard to figure out both on symptoms and imaging. Post Tulsa the size should have gone down to around 40 or 50 cc in my case and from descriptions of procedure (not from imaging which there isn't one a few months post Tulsa). That from 110 cc. So I pee'd great. But over last 1.5 years the getting up at night to pee increased. The need to go after you just went came back a bit. Jan '25 MRI size listed as 87 cc, up from post tulsa recovery which I don't have a size I will call it 50 cc. Nothing suspicious cancer wise noted on MRI, but MRI does point out BPH seems active. I just had a CT of pelvis for possible PAE and size listed as 90 to 95 cc (one place it mentions 92 and in text it says 95). So symptoms, imaging all point to BPH. I read lots of tulsa info, sometimes it stops BPH, sometimes it can't really stop BPH. But obviously the important one is cancer.

From what little I understand on BPH, I think it is predominantly in the transition zone. If I'm mistaken, maybe you know more. My lesion was in the anterior transition zone, so I expect most of the transition zone was ablated. If my understanding is correct, hopefully BPH will have been addressed for the long term. I'm wondering where your lesion was and what part of your prostate was ablated. Or maybe I'm going to be experiencing what you've experienced. But I guess I will enjoy it until it comes back. We shall see.

My lesion was same area. I think BPH is anywhere in prostate, and I guess it is hard to stop. It isn't uncommon to have to do something again on BPH, watching some videos most procedures for BPH have a 20% (or more depending on procedure) re-do or other procedure in first 5 years. But I will get roughly 2 years from the Tulsa Pro on the BPH aspects (hopefully forever on the cancer), so my BPH was kind of strong I guess. You may get 5 years or never need anything again on BPH. I hope you need nothing more on BPH.

Just want to chime in here because I was intrigued reading through this (now) rather lengthy thread. Want to post for others in a comparable situation to mine.
Just got off the phone with my friendly urologist, and shot the question to him about TULSA being a possible option for me, and he confirmed to me that it's only appropriate for low-to-intermediate stage cancer, and typically for when it's confined to one area.
I'm Gleason 8 / Class 4 / T2c, so apparently no go for this, as it's considered high grade/risk.

I don't think you contacted the right person to ask about Tulsa. The people to talk to about who qualifies and not are the people who do Tulsa Pro, and not somebody who does not. That being said we don't know your circumstances, how widespread and locations, etc - all those details may matter. I could say in my understanding, as long as your lesions are within 3 cm of the urethra that generally they may accept you. Some cases they might not due to some other factors, but one of those are not the criteria you listed which is gleason scores. Gleason scores are not a very good guide, because gleason scores don't speak about volume of say gleason 4 and so on. I consider that a major error in gleason system. I had for example one needle with all gleason 4 in it, but it was just 0.2 mm (not cm, but yes 0.2 mm) and they call that a gleason 8. One other needle of mine had 3+4 but no matter that one 0.2 mm made mine a gleason 8. It is a ridiculous system loaded with problems because of the lack of volume attribution.

All that said what I understand is some places doing Tulsa still use gleason and not distance from urethra, but other Tulsa places look at more details. So your best bet is contacting Tulsa Pro centers around the country to ask with more details in your case.

That is my best quick followup, in that you need to talk to probably multiple Tulsa Pro places. That may cost you a few bucks but likely worth it to check around, and I can't say for sure because details matter.

Just let you all folks know, I had prostatic artery embolization (PAE) 9 days ago. It is an easy procedure, no catheter needed. Should reduce my prostate back to reasonable size again, since the Tulsa pro didn't fully take care of the BPH. Hoping all stays well from here.

Late to reply....I had the TULSA procedure, and as I understand it, if the cancer has not spread out of the prostatic capsule, you are generally a candidate for TULSA. Some doctors have their limitations and preferences regarding the size of the prostate, and perhaps the proximity of cancer to some structures, so you need to visit Profoundmedical.com and look for doctors who specialize in TULSA, and ask them. Heavy calcification in the gland can be an issue, but I believe it can be addressed before TULSA. In some cases, if the cancer is not near the calcification, there are usually no issues.

UROs who do not do TULSA but other procedures are probably not the best people to ask about TULSA. Find a doctor who does TULSA and arrange a telemedicine or Zoom meeting if they are not nearby.

Good luck with whatever path you take. I had a TULSA in February, and my PSA in June was 0.10, so I am quite pleased with TULSA. I had a total ablation as I did not want to deal with this again in the future. My local URO said I made the right decision, as partial ablations using focal type therapies often result in the patient having to deal with cancer at a later date.

Thanks for posting. Where did you get Tulsa Pro? I went to Mayo Jacksonville and was turned away due to small calcium deposits. The Dr also said he wouldn't do total ablation, which I wanted, due to side effects risk.

I visited Texas Prostate in Dallas, Texas, and met with Dr. James Cochran. They are a private practice, and when I went, they did not take Medicare, so it was out of pocket for me. Take a look at WellSpan in York, PA... wellspan.org. They have done over 50 procedures by now, and the only reason I did not go there and have it covered by insurance is that I have no family to care for me after the procedure. I offered to hire a nurse practitioner, but they declined the offer. I am still bitter about that and consider them to be clowns. However, they appear to be competent with TULSA, so that is the only reason I would recommend them for anything. I hired an NP in Dallas for nursing care. Being fully mobile after the procedure, I did not require any nursing care afterwards, per se; however, it was helpful to have the nurse explain catheter care and its use. She was excellent and worth every penny, as she also helped me with travel and a few other matters. If you are married or have someone to help you, that is great. You will find that the after-procedure pain will be zero for most people; it was zero for me.

Calcifications can be an issue, but my understanding was that they could be worked around in some cases or could be removed with another procedure. I had one small calcification that was not an issue. Has your local urologist discussed the calcifications and any procedure that can remove them?

As for side effects, well, I had a total ablation, and my only side effect is dry ejaculation. At 69, I do miss that, but I also have no intentions of fathering children. The trade-off is being cancer-free. Every procedure for prostate cancer has some level of adverse events; the question is, "What can you live with?" I have minimal ED, due to low T, my Uro and I are waiting to see if my T increases; if not, then we will discuss treatment for that. I take 5mg of Cialis daily to encourage blood flow to the penile tissue. This morning, I woke up with a nice, hard erection.

Did Mayo give you a list of adverse events and tell you why those events would be worse than having cancer return if you did a focal therapy? You may have a prostate that is too large for current treatment standards, or perhaps for other reasons. I find it odd that 'side effects' from a complete ablation are the reason not to have the procedure.