I would have (should have) spent more time determining the exact extent and location of the cancer. I would have consulted with a prostate oncologist as some have suggested here.
I didn't know about color doppler or combidex mri until I read the posts from John T Would it have made any difference in my case? No, but I would have been more confident in my decision, and more knowledgeable about my prognosis. Staging still seems to me to be a very inexact science. Just look at the biopsy vs pathology experiences of the small population who post here. It would be nice to have a more precise diagnostic procedure.
I asked about other imaging techniques when I was initially diagnosed by my first urologist (after a 12 core biopsy), and was told that there was nothing else available. I didn't bring it up with my second urologist (who was also my RRP surgeon), because I had already decided on the robotic RP and he was the result of my search for the best surgeon to do the job. I was diagnosed in June of 2008 and had the surgery mid-November, so I didn't rush into anything.
I didn't qualify for HIFU (prostate too big); Brachy likewise was iffy due to size, plus I had some prostate extension into the bladder neck. This wasn't a problem for urologist #1:
"We can just lase a piece of it off", --but the oncologist who did the volume study was having none of that.
I didn't even consider external because of the potential of radiation damage to urethra, rectum, and other tissue in the path of the beam. What if I needed abdominal surgery later for some other issue? I still don't understand why anyone would chose external radiation unless he had serious medical issues that demanded this option.
Proton Beam seemed like a good way to go, and my insurance (Aetna) agreed to pay for it, but I would have had to re-locate for the 9 week procedure, plus wait to get on what was then a long list. At that time Loma Linda opened up the waiting list at the first of each month, and took a few new applicants. I made the 16 hour trip down there, and was suitably impressed. And I DO miss my prostate. Perhaps next time . . . . . (Please see prostate transplant topic).
One of the things that caught my attention while researching RP was the tremendous disparity in outcomes. Some of the posters have suggested that there are anatomical differences in patients that are responsible. That's probably true to a point, but I firmly believe the outcome is driven by the skill and motivation of the surgeon. This is a complex surgery, and teasing the nerve bundles away from the prostate capsule is time consuming and tedious. Attaching the bladder neck to the urethra also requires a high level of skill. These two items speak DIRECTLY to continence and erectile function. Some surgeons DO seem to provide consistently better outcomes than their peers.
My outcome was fantastic. Based on that fact alone I made a good decision.
Diagnosed June 2008 Gleason 6 PSA 6.5 Prostate 89 grams (measured by urologist #1 as 45 grams). On-going BPH at least 5 years previous to DX. Free PSA number drove the biopsy. Robotic RP St Alphonsus Boise on Nov 23 by Dr Todd Waldmann Nerve bundles on both sides spared. Clean margins, no extra capsular extension, no lymph node involvement. More cancerous tissue in prostate than suggested by biopsy, but still Gleason 6 Catheter removed 7 days after surgery, dry the following day, some erectile function at 3 weeks. Daily Viagra (25mg) or Cialis starting immediately after surgery, VED 3x weekly starting at 3 weeks (still do it, real pain). This is Waldmann's protocol. Actually I was already taking 25 mg Viagra daily as part of the BPH regimen, plus Avodart and Uroxatral. Two months' testosterone (Androderm patch) starting Jan 1, 2009 to counter effects of Lupron injection received in June of 2008. PSA Jan 1 2009= .01 and again April 2009= .01 w/ testosterone at 677
I think I have sufficient erectile function NOW to do the job (6 months post-op), and I enjoy spontaneous erections, usually wake up with an erection. Unfortunately, my wife has been spoiled by the VED -what's a guy to do?