Hello, Stereo...welcome to HW. Sorry you have to be here but I trust you will find this to be a helpful and caring place. I would like to offer the following thoughts on your situation and addresss some of the comments on this thread:
1. I briefly considered Cyberknife as it intuitively seems like a good alternative. The problem I had with it was the lack of long term data on either its' efficacy or side effects. Perhaps you will be able to find better info, but I'm very much data and logic driven and was unable to find convincing long term info on this alternative.
2. It is true that surgery after radiation is difficult. However, that is only part of the story. In the first place, radiation tends to treat areas slightly beyond the prostate to begin with so there is liklihood that cancer in those areas will be killed along with the cancer in the prostate. Secondly, even if the primary radiation fails, there are alternative salvage treatments that are just as effective as the salvage radiation that follows failed surgery. For example, after a failed permanent brachytherapy, one may consider implanting seeds with another isotope, HDR brachytherapy, cyrotherapy, HIFU and (of course) HT. The point is that there are salvage treatments for both failed surgery and failed radiation...they just happen to be different. You will most likely get the info about radiation backup to surgery from a uro-surgeon but you likely need to speak with a radiation oncologist or prostate oncologist to get the info about salvage treatments for failed radiaition.
3. We often hear from patients on this forum about how they value the information provided by a "final pathology" from their surgery. But, I would encourage you to ask yourself and your uro the question, "what will you do with the information once you have it?" The most frequent answer is "nothing"...since the most common thing that is done after surgery is to wait and see what happens via PSA readings. So, you may get info that a recurrance is "more likely" but unless you are prepared to enter adjuvant treatment immediately after surgery, then that info is interesting but not something on which you will take action.
4. There are a couple of references to long term radiation side effects. It is certainly true that there are rare side effects that occur with all treatments. There MAY be some peripheral radiation damange or a patient MAY die on the table during prostate surgery. However, I would encourage you to focus on main area under the curve and not the tails. Focus on the big three - cure, urinary effects and sexual effects. Most other side effects are rare in all treatments. And...if you have specific radiation concerns, you should speak to a radiation oncologist rather than relying on your urologist or on-line forums for your information.
5. If side effects and quality of life are important to you, then I would encourage you to consider brachytherapy as an option. The long term cure rate has been shown to be similar to surgery, the urinary side effects are generaly minor vis-a-vis surgery and the incidence of ED is more like 35% vs. 50% for surgery. A couple of years back the New England Journal of Medicine published a QOL survey with comparisons between the various treatment options. Despite the fact that the brachytherapy group in this study was older than the surgery group, the QOL score for both urinary and sexual functions was signifcantly higher for brachytherapy patients than for surgical patients. If you want a first person version of brachytherapy, feel free to copy and paste my "journey" at the bottom of my signature.
6. I think there are three particularly good books that you might consider reading to get a good perspective on your disease. They provide different and valuable perspectives, IMHO. The books are, "Surviving Prostate Cancer" by Walsh, "A Primer on Prostate Cancer" by Strum and "Invasion of the Prostate Snatchers" by Scholz/Blum.
Good luck and please keep us posted on your progress.
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 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey: