Thought I would add a few words to your post, you made some good points. We are a diverse bunch of men here. We range from being unemployed with no health insurance to those that are obviously of means. Money does matter, whether we agree or not. location matters, there are less options to many who live in really rural areas. The state we live in can matter, some are more sophisicated in facilities then others. Available doctors within one's practical range makes a big difference too. Even family factors in as well, the cost and logistics of having treatment in other states, counties, etc can make or break a deal with some. As usual, a lot of factors at play.
I don't like the thinking behind the phrase "knee jerk reaction" when I man gets dx. with PCa, and he chooses in a short time to go with a certain treatment, and in most cases, robotic or open RP surgery. Many men here are perfectly healthy, save for their cancer. When they get the dx., it is horrible, frightening, scary, and shocks and awes the hell out of them.
The thought that they know something is eating away at them, and that over time, it can escape, if it hasn't already, the prostate and start spreading through their bodies is totally unacceptable.
It is a normal reaction to repel the cancer, whether we are talking about some complex like PC or Breast Cancer, or something simpler like most skin cancer. Cancer is still cancer.
And for the men who get dx. when in their early 40s through late 50s, they know the math, and they realize that if they make it 5, 10, or 15 years out from treatment, they will still be relatively young. They know they got wives, and many have children still at home, or perhaps haven't had a chance to start a family yet.
A biopsy is a best guess estimate. In more cases then less, they find higher grade after surgery, only in a few cases do they ever find less. So waiting and watching when your biopsy shows a good dose of PC already just doesn't make sense to my logic, its not like its going to get better on its own.
If you are much older, or have complicated medical issues, or biopsy with a tiny, low grade, PC, then perhaps watchful waiting with frequent psa tests and regular biopsies makes sense.
If you are younger, good health, and your current biopsy shows a pretty good grade of PC in place, I still think surgery is your best shot. A. If contained, it should get the cancer out of your body. B. The post surgical pathology will give the best and fullest understanding of how severe your cancer really is.
If you have a small prostate, low psa, and low gleason, going for seeding may be best for you, I was interested at one time, but the long term survival data was sketchy at best. And if it failed, then you would be in the dilema of knowing that salvage surgery is difficult or near impossible.
If you know that your prostate cancer is not contained, then your options have to steer towared radiation, advanced radiation treatments and/or hormones. It is unfortunate, but that is the reality.
If you are a good candidate for surgery, but choose radiation first, your choice of course, but remember, salvage surgery often doesn't work, its messy, many surgeons want do it, and it too, can fail. It's a question of sequence.
In my months here at HW, I do detect (though I am not judging) that there are men who are either afraid of major surgery and/or don't want to deal with the side affects post surgery, i.e. ED issues and incontinence. These are things that all of us that choose surgery had to think through and fight through, and to be honest, its not easy, not easy when you feel perfectly healthy and well prior to surgery, and then when you are on the other side, you have to start being a patient in recovery, and some of these side affects don't happen to resolve as quickly as we want, or our doctors led us to believe. But we do it, because we want the cancer gone.
All said, I don't think the process is "knee jerk". Walking around with high and growing PSA numbers along with a know dx of PCa, is a dangerous gamble at best. And if that is a man's choice, I respect that as well as the next. But you will never know when/if/how your cancer decides to accelerate and cross that microscopic line from being contained to being loose in your body. Thats a gamble that many of us, myself included, refused to take. My wife and family wanted their husband/dad/grandad around a few more years, and would have been angry with me if I had decided to sit it out, knowing what was known after my 3rd biopsy.
Just some of my thoughts. I respect all decisions made by all men here, its their body.
David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes
First PSA Post Surgery 2/9 .05