I am on treatment #34 of 45 for advanced PCa. My local urologist did not recommend surgery due to indication of spread to the lymph nodes. I got a second opinion from the Mayo Clinic and the urologist there recommended surgery, radiation, and hormones. Mayo experience is that patients who undergo surgery improve their odds even if they must follow with radiation and/or hormone versus radiation and/or hormone only.
My local urologist and oncologist agreed that radiation and hormone treatments were my best option. I had this recommendation confirmed by a third opinion from an oncologist who is the lead doctor at a cancer center in Savannah, Ga. After some time evaluating the pros and cons and reading at least three books on PCa. ( First one was a general reference, second was focused on brachytherapy + IMRT, and the third was focused on proton therapy) I chose to go with the local urologists recommendation. As you stated my research indicated little difference in the results for advanced PCa treated with surgery or radiation. The operative word is "advanced". Localized PCa is very treatable with either modality. One research paper that I read indicated that "debulking" or removing the original tumor had a slight advantage over radiation only when evaluating reoccurence of the disease. In 50% of the cases when PCa reoccurred it was in the prostate tissue that was not completely destroyed by radiation. That means that 50% of the cases were from other sites indicating micrometastasis that was not detected prior to the treatment. Ask your doc about the Prostascint scan as it is focused on detecting cancer cells in the blood and could add a little more info on potential spread if all other tests for you are negative. My doctor did not recommend this because it is expensive and he felt that it would only be further confirmation of previous tests.
If there is no evidence of spread in your case I would take a long look at the surgery. I know this is a difficult decision as I was back and forth like a ping pong ball when I was where you are just nine weeks ago. The doctors do not make it any easier as there is no clear front runner and each doctor trends towards his or her speciality. I was impressed that my urologist, also a Da Vinci surgeon, would step aside so quickly and recommend Oncology. Speaks well of him I believe.
I will recommend another site to you for additional information on EBRT. The site is prostatepointers.org and it is arranged by treatment modality. I.E. hormone, EBRT, surgery, wait and see. I got a good deal of feedback from others who have had similar experience to mine and it helped me with my decision process. Like this board it is fairly active and if you post an inquiry you will receive replies within 24 hours.
Good luck with your journey. If you have any specific questions about my case I will be glad to answer.
PSA 21.5 (first and only test resulted from follow up visit to emergency room for kidney stone. first time for kidney stone too)
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear
Chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.