The results from surgery and radiation are the same, so it boils down to a personal choice. The cure rate your doctor stated seems high, it is probably more like 70-80%.
I don't buy into the thinking that the pathology after surgery gives you a better idea of the cancer. Even if the Gleason is upgraded or downgraded what difference does it make? The cancer is either gone or it's not gone; the changes in gleason don't make any difference in your actions. The only benefit from surgery in this regard is knowing if you have a positive margin or seminal vessel invasion. Radiation should do a better job if the cancer has slightly penetrated the margins. As for salvage radiation or surgery, both have a low probability of cure and have severe side affects.
The 0 psa after surgery is the standard. After radiation the goal is a low, non rising psa. A rising psa in both cases indicates a reoccurance. You can identify a reoccurance after surgery much faster than radiation as it may take months to get the psa to it's low point. The largest cause of reoccurance is because the cancer has already escaped the prostate gland and neither surgery or radiation can cure this type cancer effectively. If a reoccurance occurs locally it is most likely that the surgery or radiation wasn't done properly (prostate tissue left after surgery or too low a dose of radiation or dead spots in the radiation treatment. These can be eliminated if you go to the very best doctors.
So the choice is really personal and should be made after you researched all the optons and side affects.
Good luck on your husband's treatment.
64 years old.
I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.
In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.
I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.
A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.
Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,
I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.
The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.