After all the research I did after my diagnosis I came to the conclusion there are three ways to go:
Robotic (Da Vinci) RP
If your cancer is early stage, Gleason 6 and PSA under 10, AND your prostate is small (less than 40 grams), then HIFU will produce the best results with almost zero erectile or continence problems. Unfortunately, although they were trialing throughout the US last year, HIFU is still not FDA approved in the US. It has been used for years in Europe, Japan, and lesser time in Canada. You CAN have it done outside the US, but the cost runs around $25K I didn't qualify for one of the trials because of the size of my prostate, which eventually turned out to be 89 grams. You can google HIFU and HIFU Trial for more information. These are some pretty happy PC survivors, but many of us don't have the money or the qualifying prostate and cancer stage. There are two competing machines, the French Ablatherm is the best.
Proton Beam: If you live in Houston, or close to Loma Linda in So CAL, and have eight weeks plus for the therapy, AND can wait to get on the treatment list, AND your insurance will pay for it, then this is a good way to go. WWW.ProtonBob.com has details. This is NOT conventional radiation therapy. Don't let your urologist tell you that it is comparable.
Robotic (Da Vinci) RP: This has become the gold standard for the rest of us. Techniques have advanced to where quick recovery of continence and erectile function is almost assured. EVEN SO, the skill of the surgeon and his level of motivation is paramount. I can't emphasize this highly enough. The potential offered by the robot is there, but there is no guarantee you will have the same results from surgeon B as you will get from surgeon A.
Why Robotic RP? It's minimally invasive, one small vertical incision for the camera, and four very small half inch cuts for the instruments and tubes. Complete illumination and access to the abdominal cavity means the surgeon can easily inspect lymph nodes, resect nerve bundles, and make a quality re-attachment of the urethra to the bladder neck. Blood loss is minimal, you're in the hospital one night, the surgeon sits comfortably at a console to perform the surgery. Comfortable is important, the nerve sparing and bladder neck re-attachment is tedious and time-consuming. It adds almost an hour to the total time of the surgery.
If you don't want to pee your pants the rest of your life, and you (or your wife) enjoys sex, then you need to find the right surgeon.
The Da Vinci camera provides a 3D, illuminated and magnified look at everything. The prostate is removed, and can be sliced and diced to find the true extent of the cancer. You know where you stand - immediately. If you're good to go, that's that -ge on with your life. If the cancer has spread, you know where, how much, and can make plans to fight on.
If you find a competent surgeon, then you can expect my results: dry the day after the catheter was pulled, and some erectile recovery at three weeks. You can't leave this part to chance. Remember the old saying: What do they call the medical school student who graduated last in his class? The answer is "Doctor" and he could be your urologist.
Brachy and External Radiation: If you're 85 with cardiac and renal problems, and can't find a surgeon to operate on you, then these MIGHT be an option.
But why would anyone else choose the "Shot In The Dark"?? as the initial treatment procedure. The hormone therapy associated with these options will devastate you (google Lupron victims), and you still have no idea if you killed the cancer, or where it might be. You live in fear for years, until on e day, sure enough, your PSA starts to rise again. The only advantage to the "Shot In The Dark" is to your urologist's (and his partner oncologist's) college age kids. It pays their tuition. It's not going to do anything for you but delay the inevitable.
Beware the urologist who pushes Brachy or External Radiation with the words: "I get the same results" He means, he makes the same money. Actually more, because he's going to be taking care of you for years to come. Endless PSA tests, those $2700 Lupron shots. And when your PC eventually recurs, KaChinng, KaChinng. He actually gets better results!
I MAY be biased. I almost went the Brachy route. My first urologist never mentioned the robotic RP option.
I was talked into a Lupron shot. I drove to Loma Linda and checked out the Proton Beam, but would have had to move there for the treatment -and wait to get on the list.
I found a crackerjack surgeon who was relly into the Da Vinci robot (my wife is an OR nurse and was able to make the necessary, discreet inquiries as to who was competent and who was not. Outside of the medical community that information is hard to come by). At the time we only had one Da Vinci robot in our state (Idaho).
I was completely dry the day after the catheter was pulled, and had some erectile function at three weeks. It's gotten steadily better. Overcoming the results of the Lupron shot was the worst part of the cancer experience.
My PC was confined to the prostate capsule. It's easy to offer a prognosis -good or bad- when you can see the abdominal cavity so clearly during the robotic RP, and you have the prostate in hand to biopsy. With the "Shot In The Dark" you'll never know where you stand.
If you want to see what I talk about, go on YouTube and search for Da Vinci Prostatectomy The entire procedure as done at Cornell Weill is there.
This is the rest of your life we are talking about here. PC moves slowly. It's important to invest the time necessary to make the right choices.