I'm pretty new here.
Since being diagnosed Dec 3, I've looked at about every treatment option available. I'm now going through the same for the 2nd time since the amount of info here and online can be daunting. I've talked to my Uro twice, my GP several times and here is where I am in my research at this time...and, these are my opinions only:
1) da Vinci robotic RP at University Hospital in London, Canada...Dr. Joeseph Chin.. Unless I'm wrong, London, Ontario and Montreal, Quebec are the 2 centers of excellence in Canada for robotic. There are even more in the U.S. I have contacted Dr. Jean Joseph's office in Rochester, NY, also. I have not yet seen Dr. Chin. I am leaning towards this for a couple of reasons. While getting the cancer out is the priority (#1), I am concerned about recovery time, incontinence and ED (married my dream girl). I run a small biz (5 great employees) and I'm a working boss...practical considerations. With either robotic or open, there is a good chance that subsequent radiation or other treatment can be very effective, if needed. If anyone has experience with this center and doctor, please reply.
2) Proton Treatment at Loma Linda in southern California. I have had initial talks with staff there. This looks like an effective treatment and this center has treated many people. While methods are improving and results are impressive, there is still the issue of collateral tissue damage to the bowel/bladder (etc) from radiation exposure. This could make salvage surgery difficult at a later date...and it's not covered by many insurances...certainly not mine. If anyone has specific experience here, please reply.
3) HIFU, while experimental in the U.S. is offered in Toronto. It also is not covered by most insurance...including mine. Collateral damage to surrounding tissue could make future surgery as difficult as with any radiation treatment. Some advocates consider this an effective primary treatment. Both my GP and Uro considered this a salvage option. Those with experience please post a reply.
4) Cryo. Same potential side effects as radiation, HIFU and Proton therapy. Anal fistula, bowel and bladder incontinence, ED...all several years down the road. My GP and Uro viewed this as a salvage option more than a primary treatment. Covered by some insurance.
5) Photon Radiation...same potential issues as with 2), 3) and 4) above. This comes in various protocols and I haven't found much about Cyberknife and how it fits here...yet.
6) Hormone Therapy I think is for more advanced cases and sometimes used while waiting for surgery for those eligible. There are side effects that my wife and I have discussed...loss of libido, ED and mood swings, equiv of male menopause in some cases.
While I am leaning towards an RP, hopefully robotic, I am still learning and researching. It's a difficult journey and I've only just started mine. What might seem the best option for me, may not suit another. I haven't made a final decision yet. One point that seems clear to me at this time is that if you have surgery first, all the other treatments are good candidate secondary or salvage options should PSA levels rise or metastasis occur.
You need to do your own research with doctors, support groups, this forum and the vast resources out there to pick the best option for you...and for all of in early diagnosis. The veteran posters here have a wealth of experience.
I'll be starting my 3rd pass through all available treatments in a couple of weeks. Hopefully, I'll be in a position to make the call that's right for me.
PS: My 1st grandaughter was born at 3:10 pm on December 24. Mother and daughter healthy and home 24 hours later.
Lower left groin hernia; mesh and large scar: surgery early 2006
Nov/Dec 07 and March 08 and now Dec 08: Severe perineal pain (between scrotum and rectum). Septra/Bactrim for 8 months (Nov 07-Jun 08) for diagnosed prostatitis.
PSA start of 2008: 5.3
PSA June of 2008: 7.3
6 DRE all benign or nothing felt
TRUS Biopsy Nov 08: Got copy of pathology recently (see below).
General Health: pretty good, 5' 10", 180 lbs, slim.
Bone scan Dec 08: Negative
Biopsy Pathology: 5 of 8 cores positive, adenocarinoma in both lobes
1) 30%, GS 3+3, perineural invasion identified
2) 40%, GS 3+3
3) 60%, GS 3+3
4) 65%, GS 3+3
5) 30%, GS 3+3
Open RP recommended. Looking at nerve sparing da Vinci in London, Ontario.
Wonderful wife...and 1st grandchild on the way.