The problem with PC is that there are so many grey areas. There is no right or wrong answer much of the time.
When I got dx., I went to Umich Comprehensive Cancer Center. Maybe you have a similar facility near you. I met with a top-notch surgeon and a top-notch radiology expert. I was then scheduled to meet with a top-notch midical oncologist but I cancelled that meeting as all of my questions were answered based on my reading and the the meetings that day. I would suggest you read as much as possible and schedule meetings with some top-notch people in the field. In my case, AS was not an option as I was a G4+3. The next day I also met with a second surgeon (Dr. Menon and his team). I ended up doing surgery, based on all sorts of considerations. For me, I felt it afforded me a backup plan (radiation) if surgery fails. It also allowed me to get a complete pathology after the surgery so that I knew exactly what I was dealing with. I also preferred to have the surgery SE up front with the hope that it would improve. The radiation SE often appear 1-3 years after the treatments and can stay around. In my case, the surgery was not curative and the subsequent radiation was not curative so I am now on HT. However, my decisions were well thought out and I have no regrets whatsoever. Incidentally, after surgery I had incontinence that cleared up totally within maybe 2 weeks. There has been a degree of ED too.
In your case, AS may be an option, but it depends on how you view things. For me, even if it had been an option, I don't think my mentality would allow me to do it. I'm a "get it out" kind of person. But that is a very individualistic choice. AS does NOT mean doing nothing. It would mean frequent PSA tests and I assume occassional subsequent biopsies. Another aspect that would have disuaded me is seeing too many people getting a worse Gleason score after surgery than they had before surgery. If you TRULY have a G6, the odds are overwhelming that it is indolent. Very very few of the g6 cancers metasticize. The problem is that you don't know for sure that it is a G6.
Another thing you can do is get a second opinion on the slides. I sent mine in to Dr. Jonathon Epstein at Hopkins. He is one of the foremost experts in the field. He actually called me personally, confirming the Umich biopsy report. Oddly enough, when I decided to have my surgery done at Ford Hospital in Detroit, they reread my slides and said it was a G3+4. But post-surgery it again was a 4+3.
It sure would be nice to get a definitive answer in terms of what to do. There is none. You have to find youw own way. Read a lot. I also read a lot on this Forum. It was clear that some people just had a particular axe to grind. I could read the name and know exactly what they were going to say. But, eventually, if you read enough of these threads, you will get a good spectrum of information.
Good luck to you
Post Edited (compiler) : 4/23/2013 10:56:59 AM (GMT-6)