Alright, so our first question is, they want your opinion of cryotherapy. So, you've obviously
referred patients, I know, so what was your experience with that?
So, yeah, just to be clear, cryotherapy is... They put little probes in the prostate and
then freeze—create an ice ball and the... it's been around a long time. It works. Cure
rates in the hands of experts are excellent. It never really got super popular because
if you freeze the whole prostate almost everyone becomes impotent, and, of course, the numbers
aren't great with surgery or radiation, but some people make it through with surgery and
radiation. Really, no one makes it through when whole-gland cryotherapy is done. But,
the cryotherapy methodology does set up well for doing focal treatments. So, rather than
trying to freeze the whole prostate, just freezing the area where the cancer is is feasible
in skilled hands. And, we've worked a lot with a specialist out in Ventura, California
named Dr. Duke Bahn, B-A-H-N, who is an interventional radiologist, and I think that's really an
important thing whenever you talk about focal therapy. The imaging skills that are necessary
to see where the cancer is in the prostate are really tricky and you need someone who
is very good at it, and then, of course, they have to have good hand-eye coordination and
good common sense about how big a margin to put around the spot. And, so we've had a number
of patients through the years have really good results in the hands of Dr. Bahn and
I'm sure there are other good cryosurgeons throughout the country that can do good focal
cryotherapy in carefully selected patients. So, it's a nice technique. You have to have
a catheter in for about three or four or five days after the procedure which then is removed
and people generally do well. The men that are getting focal cryotherapy still have a
risk of erectile dysfunction. It's probably in a range of 10-20%, so it's not a get out
of jail free card, but it's pretty effective and the cure rates seem durable.
Okay. I was reading on the Mayo Clinic website, they were talking about that there is a chance
of some urethral blockage. Have you seen that in any of the patients? So that's the reason
for the catheter. So when you go in and freeze a section of the prostate there's a lot of
swelling for about a week afterward and if that swelling puts pressure on the urinary
passage, the urethra, then you can blockage, and so as a pre-emptive or a preventative
methodology, they leave a catheter in for about a week, wait for the swelling to die
down, and then remove the catheter. And I haven't seen any problems with blockage as
a result.
Okay, and you mentioned erectile dysfunction as a side effect. Are there any other side
effects that patients should be aware of?
I think the other side effects would be mostly in the hands of unskilled doctors. So if the
doctor were to freeze into the bladder or the rectum, you've got a total disaster on
your hands. I have never seen that in Dr. Bahn's hand. He's probably one of the best
in the world. So, like so many things in the prostate cancer world, you really want to
search out your experts, find the people, really, that are on top of their game, and
then the toxicity from focal cryo should be limited to some erectile dysfunction in some
patients. Of course, as an operative procedure, you go in the hospital, and rarely mistakes
can be made of all sorts when you go to the hospital, but the—but no, apart from the
erectile dysfunction, that's about it.
Okay, and in comparison to other treatments for that stage of, you know, using it as a
focal treatment, what would you suggest? Do you think cryo is better than IMRT or anything
else?
The methodology, in my opinion, is much less important than the doctor who is doing it.
So much judgment and skill is required in hitting these little tiny targets and trying
to miss the very sensitive structures that are so close. So, I'm not for or against any
of these other methodologies per se. We've worked with a lot of radiation therapists
to do focal radiation. The radiation doctors are trained from the get-go in targeting and
radiation is the one form of treatment that doesn't destroy the tissue the way that cryo
and HIFU and laser do. It just paints some radiation over the normal tissue, so it leaves
the prostate intact, and I don't know if that will translate into maybe a slightly lower
incidence of side effects or not. There are no studies yet. But, I think the thing to
remember is to pick the doctor, not the treatment.
Yeah, I wish that was kind of shouted from the rooftops and I think PCRI is continuing
to pound the drum, but we'll continue to do it louder in the future. I don't see many
people on the internet who are sitting there studying doctors versus treatments and so...
Yeah, so I mean let's talk just briefly about that. So, online reviews seem to be helpful.
Support groups that are in the geographic area of a doctor you're considering—visit
them, talk to the patients that have had care through those physicians. People develop a
reputation over time. Primary care physicians that are referring a significant number of
patients may have some sense of how they're turning out if they send a goodly number of
people to a specific doctor. So, those are all ways to try and check out how good a doctor
really is.
Right, Right.
So, if you have questions that you would like me to ask Dr. Scholz in the future, you can
go ahead and leave that in the Youtube comments below and we will pick them up from there.
In the meantime, if you have more questions that you would like to ask to a person, someone
who can talk to you about your prostate cancer case as an individual, our Helpline is available
to you and you can go ahead and submit your questions at PCRI.ORG. For more information
about prostate cancer, in general, you can also visit our website and please subscribe
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