I assume you are referring to my posts.
I really won't argue with you too much. You make excellent points. Clearly, what we can do is also a function of our health and resources. In many cases, the costs would be prohibitive. Also, in many cases, it is just way too difficult physically to travel.
In fact, I know one concern I have in the deeper recesses of my brain: fast forward and suppose one has advanced PC with significant, disabling symptoms. It would be great to have a great doctor locally.
All that being said, if you have complete confidence in your local medico and feel this person is extremely knowledgeable in advanced PC, that's fine. These folks are few and far between.
I have no confidence in anyone locally, in this tri-city area. (I live in a major tri-city area). We have a number of medical oncologists. NONE of them are true specialists in PC. One of them spoke at our local support group and in response to a very clear question, to wit "I recently had an RP; at what PSA level would SRT be required" he INSISTED that it was 2.0.
C'mon. We KNOW that's not true. We can debate 0.20 vs 0.30 vs. 0.50, but 2.0?? Yeah, if that person was not an internet person and just blindly relied on his great local oncologist, he could follow that VERY POOR advice. Fortunately, that participant knew better.
We are all dealing with a life-threatening illness. There are no guarantees. Period. I picked arguably the best surgeon. As David keeps reminding me, and I readily agree, it did not stop the BCR. Fortunately, I avoided incontinence and I recovered very well from the surgery, so at least that wasn't bungled. But there are no guarantees.
I am not amiss to going local if you have a good expert. In fact, my RO is local and I can only HOPE he is good and did a good job.
I maintain your chances are better when the doctor is better.