Questions for a focal ablation therapist

Questions for focal ablation therapists (read this link first)

1.     Am I a good candidate for focal ablation? Why do you say that?

2.     What about proximity to other organs – urethra, bladder neck, rectum?

3.     How would you assess my risk of urethral stenosis requiring catheterization?

4.     Is there a risk of recto-urethral fistula?

5.     Should I expect some incontinence for a while? For how long?

6.     What about damage to the neuro-vascular bundles on one or both sides?

7.     What is the risk of losing the ability to have erections? Orgasms? or have painful orgasms?

8.     What is the likelihood that I will still be able to ejaculate at orgasm?

9.     Should I expect blood in semen? In urine? Is climacturia ever an issue?

10. Should I expect bleeding and sloughing of necrotic tissue through my penis?

11. How long after the procedure can I have anal receptive sex?

12. What is the likelihood that undetected cancer in the untreated area will become a problem? How will we monitor that?

13. What is the likelihood that cancer in the treated area will not be fully killed off? How will we monitor that?

14. Will we use imaging (mpMRI or PET/CT) to assure the cancer is gone? Will we do a follow-up biopsy? Is there a pathologist here who is expert at reading biopsies of ablated tissue?

15. How will we monitor progression after the procedure? Since my PSA from the unablated zone will always be there, how do we know if progression has occurred?

16. What is the cost of the procedure? Does that include anesthesia?

17. What is the cost of a re-do, if I need one?

18. Are any of the costs covered by insurance?

19. How many focal ablations (as a primary therapy) have you done?

20. Have you always used the same equipment?

21. How has your practice changed over the years?

22. Are you going to be doing all of the really important parts of my procedure yourself?

23. What percent of those required re-dos?

24. What percent eventually needed other salvage therapies? What kinds of salvage therapies were used? Radiation? Surgery? Were they successful? What kinds of side effects occurred from the salvage?

25. What is the longest follow-up you’ve done of patients you’ve treated?

26. How long should follow-up be before we deem it a success, or am I always on “active surveillance”?

27. What kind of aftercare will you provide, and how will we monitor side effects, and for how long? Will you regularly monitor my urinary and erectile recovery progress with validated questionnaires like EPIC and IPSS?

28. What is the best way for us to communicate? May I ask short questions by email?

Questions not to ask:

1.     What treatments should I consider and which is the best for me? (this would be asking your doctor to be an expert in treatments outside of his specialty, and also to know which benefits and risks are most important to you – he doesn’t have time or inclination to be expert in all therapies, and he’s not a mind reader.)

2.     If I were your father, what would you recommend? (You don’t know how he feels about his father (lol), and more importantly, what he would feel most comfortable with is not necessarily what you would feel most comfortable with. This is your decision to make and live with – don’t give up your power!)