Has anyone had cryosurgery as a first line treatment?

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georcass
New Member


Date Joined Apr 2010
Total Posts : 16
   Posted 4/21/2010 1:59 PM (GMT -6)   
Hello Everyone - I am a newbie to the forum.  My husband was dx with PCa on Jan 21sth of this year.  He is 77, but extremely strong, active, and (other than PCa) very healthy.  His BMI is 25, he does not smoke or drink.  At the time of his dx, his PSA was 19.  3 of 12 cores were cancerous on biopsy.  Two of the cores (right base) showed diffuse adenocancinoma.  Gleason score 3+4=7.  Because of his age, his only options were 9 weeks of EBRT with Hormone ablation therapy for at least 6 months or cryosurgery.  He chose the cryo.  He is 4 and 1/2 weeks past surgery, and is still not "up to speed".  He gets really tired with moderate activity.  Currently he has a bladder infection.  The suprapubic catheter was not taken out until last Thursday.  We do not go back to the uro until July 8th, bit I am wondering what to expect next.  He will have his PSA tested prior to the office visit, but what is the next line of treatment if it has not gone down.  The uro said it should be less than 1.  I have been reading about the salvage radiation therapies, but I wonder if that would be needed after cryo.
 
Any help or advice you can give would be greatly appreciated as I am very worried about him.  Thank you all.
 
Georgeann 

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4849
   Posted 4/21/2010 2:34 PM (GMT -6)   

Hey Georgeann - welcome to the site. Glad you found us.

I can't answer your question but am sure someone else can. Hang tight and let us know how it goes.


Age 55   - 5'11"   215lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 4/21/2010 7:25 PM (GMT -6)   
The usual salvage treatment for failed cryo is more cryo. The cancer must be determined to be local in order to undergo any salvage therapy.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 4/22/2010 11:25 AM (GMT -6)   

Georgeann,

I had cryo back in 2006. During the past year my psa has climbed, doubling to 1.5 in six months. However, I just had a follow-up biopsy that confirmed there was no prostate cancer in what was left of my gland plus the seminal vesicles. Had there been any signs of cancer, I would have been able to get another cryo or radiation.

First things first, your husband's weakness is likely attributable to the bladder infection and possibly some depression due to having the catheter for three or so weeks. The cryo itself, should not have any bearing on one's strength.

Next....do not assume that the cryo failed. If done right, it kills the monster very well. As to psa readings....the lower the better; however the reason why your doc said less than 1.0 is because there is always the possibility that some prostate tissue may still be alive---however, the higher the psa reading, the higher the potential that both healthy AND cancerous tissue is still alive. Studies have suggested that a nadir of 0.5 or less is indicative that there is a good chance the cancer in the prostate has been eliminated. My nadir was 0.2; many men go lower than that. As to failure...your doc uses 1.0; my doc uses 2.0 + nadir (in my case 2.2); I have thrown the towel in at 1.5, mostly because the doubling time is now looking to be rapid. Anyway, if the initial reading is less than 1.0, your doc will not recommend doing anything now; that will be determined after subsequent readings, showing doubling time, etc. If the initial reading is over 1.0, I believe your doc will want to do further testing and possibly another cryo or radiation, if cancer is still found in the prostate or seminal vessicles. BTW: your doc will do another biopsy ANYWAY (six months after), no matter what the initial psa is. That is to ensure, to the degree possible, that all of the cancer was killed, regardless of the psa reading.

Hope this helps!

 

 


Age -57; Diagnosed 10/05 PSA 13.4 GS 7 (4+3) Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09)
Doubled to 1.5 (2/10) YUCH!
Hoping to qualify for salvage cryo or radiation


georcass
New Member


Date Joined Apr 2010
Total Posts : 16
   Posted 4/22/2010 4:10 PM (GMT -6)   
Thank you Joey - That takes some of my worries away. Yes, he is very depressed. I am trying to help all I can, but, you know, the ED in addition to the weakness has him down. BTW, you have the same doc as us. I hope he helps us with our ED problem. Did he help you. We have been trying some things on our own, but it hasn't been too good to date.

Good talking to you.

georgeann

georcass
New Member


Date Joined Apr 2010
Total Posts : 16
   Posted 4/22/2010 6:09 PM (GMT -6)   
Joey, the more I read about your case, the more it reminds of ours. You may not realize it, but you have given me so much hope. I had read Dr. Walsh's book, and had familiarized myself with the Partin tables. With his numbers, I was sure the cancer was not organ confined. My husband's tumor was also clinical T2b. Your PSA was way over 10 also and your gleason was similiar to his. I just hope you are still going to be okay. How and when will you know if you qualify for salvage cryo or radiation. I'll keep you in my prayers.

Georgeann

JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 4/26/2010 8:19 AM (GMT -6)   
Hi Georgeann,
 
Your husband had one of the top cryosurgeons, trust me on that.
 
Thinking back, yes he wants to see a nadir (first reading) of less than 1 but, as I said, the lower the better. A follow-up biopsy will confirm if there is no more PCa.
 
As to ED, the doc like Cialis. try it. Both Cialis and Viagra got me to 85-90%. If not, Trimex (injections) usually do the job. Where there is a will, there is a way (hopefully). What really is crappy is I am going on my wife's insurance (UPMC) in July, following my retirement. UPMC covers NO ED medication. However, with a prescription, you can order overseas at a very reasonable price.
 
As to me, I definetely do not qualify for a re-freezing and radiation is a pie-in-the-sky crap shoot. Therefore, I will be going on hormone treatments, sooner or later.
 
I hope your husband starts to feel better. A good psa report will likely make all of this history. Hope so!
 
Joey G
 
 
Age -57; Diagnosed 10/05 PSA 13.4 GS 7 (4+3) Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09)
Doubled to 1.5 (2/10) YUCH!
Hoping to qualify for salvage cryo or radiation


georcass
New Member


Date Joined Apr 2010
Total Posts : 16
   Posted 4/28/2010 8:44 AM (GMT -6)   
Joey - Thank you so much for your encouranging words. You've been like an angel of hope to me. I will keep praying for you and I wish you all the best. Btw, would you possibly be a candidate for Provenge? I have read a lot about it, and it seems to offer a lot of hope.

Thank you again and all my best to you.

Georgeann
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