IMG_0097It’s been a little over a year since we’ve posted an update. During that time we made a cross-country move and are now living in Denver, Colorado.  As we continue to get inquiries about our experience in Germany, the Marinus Clinic and the results of the alternative treatment for prostate cancer (transurethral hyperthermia) Paul received in 2015, here’s an update and answers to the two questions we receive most often:

Did the transurethral hyperthermia treatment work?  This seems like a very straightforward question yet Paul and I would give you two different answers. It is my opinion that the treatment did not work (if you define “work” as eliminating Paul’s prostate cancer.) While Paul’s PSA dropped slightly after treatment, it returned to its previous levels within six months. Since we began investigating this treatment I have been looking for anyone who had a definitive diagnosis of prostate cancer who was cured (e.g. their cancer disappeared) after receiving transurethral hyperthermia. I have yet to find one single person who was cured, although we have talked to several men who believe that the treatment helped them.  Many of the people who have had a degree of success with the treatment were initially treated for longer periods of time (three weeks vs. the one week that Paul was treated.) Several of these men have returned to Germany for second, third and fourth treatments.

Paul’s opinion is that the treatment slowed the progression of his cancer (as evidenced by MRI images, DRE’s and PSA’s) and gave him some time before additional treatment was required.  If the travel time and expense were no object, he would likely repeat the procedure as needed until active surveillance results dictate he take more aggressive action.

What happens now? Since relocating to Denver last year, Paul has been seeing Dr. E. David Crawford at the University of Colorado medical center. We chose Dr. Crawford because he offers a procedure called targeted focal therapy. The science behind focal therapy is to reduce the amount of damage to the prostate gland and surrounding areas while still treating the cancer effectively. Focal therapy uses ablation, which is the use of extreme temperatures (in this case, cryo-therapy) to destroy cancerous tumors. In focal ablation, the area of the prostate that contains the most serious cancer is targeted, rather than treating the entire prostate gland. This reduces the incidence of side effects and leaves the prostate gland in tact.

Although there are no set rules about which patients make the best candidates for targeted focal therapy, those with overall low or intermediate risk, and who have biopsy-proven cancer located in only one area, are usually the best choices for this type of treatment. (We already know that Paul has cancer in multiple areas of his prostate.
Last week Paul underwent a mapping biopsy (aka saturation biopsy) where 65 cores were taken from his prostate and analyzed. A mapping biopsy differs from the previous biopsies Paul had because the doctors view a 3D map of the prostate that is overlayed with a digital grid. This ensure that cores are taken from all sections of the prostate and it predicts with 98% accuracy the type and scope of the cancer. It is also a more difficult procedure from the standpoint that it is done under general anesthesia and the recovery time for the patient is longer. This mapping biopsy was required in order to determine whether or not Paul is a candidate for targeted focal therapy.

The results showed cancer in 13 of the 65 cores that were collected. Six of the cores had a Gleason score of 3+4=7 (low 7), and  six of the cores had a Gleason score of 4+3=7 (high 7).  There was one 4+4=8 but Dr. Crawford said it was likely a clipped core and part of a pattern 3+4 from an adjacent tumor, so his overall score would still be a low or high 7.  The only unexpected result was that the biopsy showed slight seminal vesicle involvement, indicating that the cancer is spreading within the organ, although it is still contained.

Our next step is to consult with Dr. Crawford to determine whether or not the targeted focal therapy cryo treatment is still a viable option given the seminal vesicle involvement and proximity of a couple of the tumors to an erectile nerve. We should know that answer in the next week or so although the procedure can’t be performed for a couple of months because Paul’s body needs time to fully recover from the biopsy.

Additionally, there is another procedure Paul is evaluating called super selective intraprostatic androgen deprivation which is being pioneered Israel. This procedure reportedly deals with the root cause of prostate cancer, which is the excess free testosterone in the prostate that causes and feeds the cancer.  There are one-way valves in the internal spermatic veins that fail over time and divert free testosterone at high concentrations directly from the testes into the prostate,causing testosterone levels in the prostate to be 130x that in general blood circulation, which increases cell proliferation in the prostate and causes BPH and ultimately can cause cells to mutate into cancerous tumors. Ideal candidates for the procedure to fix this condition are those with Gleason 3+3=6 but it has also been performed on Gleason 7 patients. Paul has not spoken to the doctor in Israel yet but plans to consult with him in early 2018.  This procedure would not be covered by insurance and would cost around $16K USD, plus travel to Israel.

We’re planning to thoroughly evaluate both options as well as the conventional treatments (surgery, radiation, etc.) offered in the U.S. and will provide additional updates as we finalize our plans.

In the meantime, wishing all of you a HAPPY AND HEALTHY 2018.