with a G6 and only one core positive and nothing felt on a DRE, low psa and 64 years old, Active Survelience is the recommended treatment by the Prostate Cancer Research Institute. Their web site has a section on active survelience and many papers written by the top minds in the PC world.
You have over a 75% chance of no progression and if eventually treated a 1% chance of dying. At worse you can delay treatments and their side affects for years. Get a doctor that is experienced in AS, a prostate oncologist would be the best.
If you have surgery there is a 40% chance of failure (Sardino's numbers at Slone Kettering) defined as no cure, permanet side affects, or major complications. You will be incontinent for a period of time and have ED for a period of time if everything goes well. There are other effects of surgery rarely mentioned such as urinating during sex. If you do decide on surgery there is a 90% or better cure rate with your stats. (the same goes for radiation or seeds)
If you were 35 0r 40 surgery may have a small long term advantage over the other treatments, but at 64 I would choose the treatment with the least side affects.
This is a life changing decision and you have a lot of time to make a decision, so don't rush it and get a 2nd opinion from a prostate oncologist who is not biased in recommending a treatment option.
Stephen Strum, one of the best PC practioners in the country, has one mantra:
Know the biology of your individual cancer.
Choose the treatment that best matches that biology.
Choose the best expert in that treatment.
Most doctors and patients don't spend nearly enough time on steps one and two. PC is slow growing and you have probably had it for 20 or 30 years, so a few months of research won't matter in it's growth, but could afffect your quality of life for the rest of your life.
64 years old.
PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.
2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.
Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.
Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.
Scheduled for 5 weeks IMRT in July