There is no simplistic answers in PCa, just somewhat simplistic choices. You have some high risk PCa within that pathology shown. Was it even done by a reknown expert like Bostwick, Oppenheimer, Epstein, Grignon etc.? Still could be reviewed and further tested for AR (androgen receptor expression-Chromagrainin testing), further tests optionals like various PCa variant types(24+), ploidy analysis (3), and gene expressions i.e. BCL2, P53, HER1 and such things...only a few experts can test this...it will become common place in the nearer future). Some of those have prognosis value and some oncologists use that information, the uro-docs don't look outside their own domain to much, they want to get busy.
So much is unknown and non-definitive enough on all us patients, that it boils down to a gamble, nobody knows if PCa has escaped the capsule, even with clean post surgery and all clear verbage(we got it all)....we have some PCa patients here in whom found BCR/failure. They cannot see or predict micro mets with any perfection...you get a best guess analysis and some people don't even get that much. Did you check out nomograms and partin tables to see how averages like your stats, have stacked up...still no guarantees. You may end up with salvage radiation as next protocol (SRT) and so you might have to think do I need surgery on top of radiations(having a risker original scenario)? I could bypass surgery and the radiations could get beyond the gland anyway (pelvic radiations) or brachy seeds and IMRT combined is a very good shot at this(and other choices)...I had worse stats like in my case..was not all curative in my protocols..then you go to HT drug therapies. So you really need to think it out, like a chess game if possible?
I was denied surgery by Dr. Menon and glad he told me the truth flat out. Another surgeon I saw a couple days before (more of a rookie in comparison) was guaranting me a cure and 1% of incontinence....I smelled the b.s. sales job and fired him immediately, also fired one onco-doc in the beginning(inept) and one radiologists (she actually lied about
the equipment available in our area and if they even owned IMRT machines at their hospital, they had them but not using them on PCa in 2002). Wonderful world out there.
Tough decisions in every move and no rewind in this, best to you in whatever you decide. In this game either you choose the moves or let someone else choose or be the referee and play nicely together. Hope whatever choice(s) you decide have your own input and decisions, only you walk the walk and live with whatever side effects from anything.
Best to you.
Post Edited (zufus) : 5/16/2011 9:44:50 AM (GMT-6)