Many patients spend a lot of time researching their treatment options. I think that a more productive approach would be spending time getting more information on your individual PC; then the correct option will be more apparent.
Most patients have thier Gleason score, one or two PSA readings and the % of cores from the biopsy. In many cases this is adequate, but the more information you have the better the outcome will be, and you may avoid a treatment option that would not be effective.
The key is making a decision is based on the TOTALITY of all information, not just one or two pieces.
Some additional information and how to use it:
PCA3: can indicate the agressiveness of your PC.
PSA derivatives and kenetics: PSA doubling time, PSA velocity, PSA density. these can indicate how your PC is behaving or growing.
Tumor volume: Can be determined by scans or using a formula that calculates volume by gleason and psa.
Tumor location: By DRE or scans like MRIS or color doppler. You can determine likelyhood of a positive margin and also the agressiveness of the tumor.
PAP; Indicates if the PC has spread beyond the prostate.
Combides MRI: indicates lymphnode involvement.
2nd opinion on original pathology.
3D mapping: multicore biopsy that takes many more samples of your prosate.
2nd and 3rd opinions from noted specialists in Surgery, radiology and oncology. You can learn something from each field that will be different.
Partin tables and Nomograms are useful in predicting the effectivness of various treatments on your individual PC.
Bone and CT scans can indicate matastis, but only if your psa is over 20.
Using all this information you can come to a high probability of what type of PC you have and the seriousness of it. Nothing in the PC world is 100% but you can surely improve the odds with more information.
64 years old.
PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.
2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.
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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.
Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.
25 treatments of IMRT 6 weeks after seed implants. No side affects at all.
PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.