Hi Mac, you have raised the age old question that has been debated and discussed on this forum many times but we are always happy to weigh in again for a new patient. Like you I was in good health and had a long life expectancy. I also consulted multiple doctors and researched this disease for untold hours. At the end of the day for me it came down to logic and not emotion. Here are the things I considered and it becomes clear why I chose radiation (brachytherapy for me):
1. Cure. In my case (and yours if I understand your stats correctly) the chances of cure were essentially the same for both options.
2. The procedure itself. Surgery was a big deal with potentially difficult recuperation. Brachytherapy was an out-patient procedure where I was back to all of my normal activities in a couple of days.
3. Urinary side effects. Surgery gives incontinence for some time...potentially some incontinence for years. Brachy gave me some urgency and frequency for a couple of months that was no big deal.
4. Sexual side effects. Surgery usually brings ED that may get better over time. Brachy usually has no immediate ED but it may get worse after a couple of years. Studies show the long term ED for surgery is worse. Also surgery brings other sexual side effects that are not well publicized, e.g. shorter penis, no ejaculate, ejaculating urine.
5. Backup plan. With surgery there is the possibility of radiation later if the initial treatment fails. With radiation surgery later is quite difficult. This is true but only part of the story...and the part that urologists who want to sell surgery usually tell. The truth is that there are backup plans with radiation that include re-seeding with another isotope, cyrotherapy, HIFU and surgery with a real expert. "Cure" from a salvage treatment only results if the cancer is confined to the prostate. And, the salvage results are generally the same for salvage after surgery or radiation.
6. Knowing the final pathology. This is a big "so what"? Even with final pathology known after surgery most patients will do nothing until they get further evidence of cancer, e.g. rising PSA. So the question is whether or not that knowledge is worth having surgery for. In my case, the answer was clearly "no".
7. What if the pathology indicated that my Gleason was higher? Again, "so what?" The radiation treatment is an effective as surgery with different G scores.
So, that was it for me. Pure logic including the major fact that quality of life was important to me. BTW, if you don't choose AS or one of the "usual" treatments, you could also consider something like targeted focal therapy which is showing great promise.
Good luck and keep us posted,
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 9/10/10. 6 month PSA 1.4, 1 year PSA at 1.0. My docs are "delighted"! My journey: