I was diagnosed November 2008, Gleason (3+3)6 2 of 12 5% PSA 3.5 and fairly steady over about 5 years stage T1c
From your intial post it sounds like you have time to investigate, you do not need to rush to a decision. Some additional information would be helpful. Has the doc staged your cancer? Do you have a PSA history? Do you know your prostate volume? Calculations of PSA doubling time and PSA density can be helpful.
There are many good resources available. As mentioned in other posts the Prostate Cancer Research Institute has a wealth of information. There are calculators for PSAV and PSAD. In addition there are mailing lists on several topics including surgery, radiation, new diagnosis, asking a physician, incontinence and intimacy as examples.
Another excellent resource is USToo (www.ustoo.org
). There are links on their site providing lots of info. You may also be able to find a chapter near you that you could contact. At our chapter in Illinois we are lucky to have a very knowledgeable individual to talk with. At our monthly meetings there is the opportunity to talk to men that have been through what you are thinking of doing. There is also a partners group providing information and support to partners of men with PCa.
I strongly agree with the suggestion made to get second (and third and even fourth) opinions. One of the first places to start is by having your slides read by another pathologist. Did a local lab read your slides? Reading slides is as much an art as a science. Most labs do not have an issue in sending the slides to another lab for reading. If yours does, remind them they are your slides and you have the right to have them sent. The original slides should be sent and they should be returned. One of the top labs to have your slides read at is Bostwick Labs in TN I believe. If you go to another doctor he may have his own lab read them.
My wife coordinated having my slides read by 4 different labs. I was lucky, as in my case all readings agreed within a very small range. I felt confident then that I was dealing with good (accurate) numbers. There have been many cases where the gleason score was upgraded (or even downgraded) with further readings.
Unless you are dealing with a Urological group that has different specialists on staff (radiation oncologist, urological oncologist, surgical urologist and others) you are probably dealing with a Urologist that provides one treatment, and in your case, it sounds like his specialty is surgery. The unfortunate thing is that it is then up to you to investigate and understand the options. That in part is why you need other opinions and why the resources above are so valuable in helping to understand the options, pros and cons and complications.
The Dattoli Center is a radioloigcal oncologist group in Sarasota, FL that has a very good reputation and is doing advanced work with radiological treatments. They are however concentrated on radiology and could be one very good source of information.
In dealing with a surgeon one thing that is very important is the experience the surgeon has. Ask your doctor how many surgeries he has performed, both open and robotic. The more the better. In one retrospective study I read was a coorolation between the number of surgeries done and long term outcome. The number they quoted was 200 surgeries.
Any treatment has risks. The doctors. may not tell you all the risks. For example, in radiation there are possible rectal issues that the radiologist had not mentioned to me. In any surgery there is a risk or reaction to the drugs and death (around 0.3%) as well as the risk of infection. Even with nerve sparing there are complications. Incontinence runs about 10%, impotence about 32%. All these numbers are only numbers or odds until they apply to you (both numbers from European Association of Urology Supplement 8 (2009) 418-423).
There is not a perfect option. It is your decision. The decision needs to be made both on medical and emotional factors. How well you can tolorate an option, what quality of life issues are important to you as well as things only you know.
I have been researching PCa and options for the last year. As I learned I had time, I cancelled surgery to give myself time to think. My wife has been very valuable in helping to organize and set up appointments as well as helping me to slow down. As a result and given my numbers I have chosen Active Surveillence as my current treatment. I have recently joined an AS research study with a Urological practice at the local hospital. It involves regular blood and urine testing as well as exams. The disease will be monitored closely. Should there be a change in the numbers or staging I will then seek other treatment.
This option has advantages as well as disadvantages. The pros are that I don't have the complications of other treatments and that it allows time for further advances which are being made in PCa treatment all the time. Robotic surgery is fairly new and has reduced complications as experience grows. There are trials that should be starting soon with nano-robotic delivery of medication directly to the tumor that holds promise.
There are also downsides. Quarterly blood tests, semi-annual DRE's, annual biopsies. They all have risks. The risk of blood infection from a biopsy is less than 1%. Unfortunately for me, I became one of the less than 1% after my last biopsy.
I have probaly gone on too long. I have been a part of USToo for a year now. I have done a lot of research. The best advice is follow the resources listed here and in other posts. Talk to guys who have been through it. Don't let anyone tell you what you "should" do (including the doctors). Get second opinions, include your feelings in the decision, as quality of life means different things to different people. Most importantly, make your own decision from a position of knowledge.