You have come to the right place to start your journey and decide on what PCa treatment will be best for you after extensive research. Some believe that surgery gives an edge in survivial (especially for younger men), but some studies have indicated, depending on your stage of cancer, that all treatments may all produce similar results. So much depends on whether or not the cancer has escaped beyond the prostate (to the margins) and to what degree.
Surgery tells you immediately if your PSA goes to "0" and also allows the prostate to be biopsied to confirm your exact stage of cancer (sometimes it is worse than projected by the pre-treatment tests). While the surgeon will undoubtedly look for and remove cancer from the margins, it may be impossible to remove it all, especially if it is microscopic in nature. The post-surgery biopsy should indicate if the cancer had spread beyond the margins. Surgery can, however, produce negative incontinence and impotence side effects that other treatments may avoid to a larger degree. Even with surgery, there is no guarantee that the cancer will not return. It can recur with any type of treatment, especially if the cancer has progressed beyond the earlier stages. With radiation you have to wait up to 24 months or more for the PSA to reach its nadir (low point). Radiation treatment usually radiates some portion of the margins around the prostate to hopefully catch any cancer which may have escaped beyond the prostate. If cancer is found in the margins after surgery, then you often also have to be treated with radiation. I consulted with a PCa medical oncologist at a top cancer center and he concluded with me that I had an equal chance of a cure with any of the treatments. If you can consult with a PCa medical oncologist it may be helpful in your decision making process. One of the most important aspects of making a treatment decision is to get a top doctor to treat you, even if you have to travel from your home area.
None of the foregoing swayed me to have surgery, notwithstanding that I consulted with a top robotic surgeon. There is a link below (see signature footnote) to my journey with prostate cancer. I chose proton radiation--you should educate yourself about
the advantages/disadvantages of proton radiation and all other treatments. Other than surgery, some of the members here have been treated with proton radiation, IMRT/IMGT x-ray radiation and also brachytherapy. The majority of members here have been treated with surgery, but don't let that unduly sway you in making your choice. There is also a subject index at the top of Page 1, which includes a list of suggested books to read. Also, you may want to visit the website http://www.yananow.net
(You are not alone) which tells the experiences of men who have treated with all of the present PCa treatment options. They often give contact information so that you can network with them via e-mail or phone which is very helpful. I was able to contact a patient who was treated with proton radiaiton which helped to convince me that it was the right choice for me. Whatever you decide on, best of luck.
-29 core biopsy 9/27/06 at age 68
-PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area], Gleason 6 [less than 5% in two other areas], Negative DRE, bone scan and Endorectal MRI.
-Completed 39 Proton radiation treatments 2/22/07-4/18/07.
-PSA History: 7.1 pre-treatment; post treatment: 2.1 (3 mo.), 2.4 (6 mo.), 1.7 (9 mo). Radiation oncologist said the 3-mo. drop of 70% exceeded expectations and the slight 6-mo. movement upwards was not a cause for concern now.
-The following is a link to My Journey With Prostate Cancer -- Proton RadiationTherapy.
Post Edited (pcdave) : 1/29/2008 6:17:11 PM (GMT-7)