Why would you go into surgery anticipating radiation afterwards? The side effects are much worse than if you just have radiation to begin with. Radiation treats an area outside the prostate that surgery can't reach, so the surgery failure rates are higher for intermediate risk cases like yours.
Have you read the sticky "Newly diagnosed with PC?"?
IMO, you owe it to yourself to talk to a variety of specialists and take your time to make a well-considered decision.
Mortality rates for intermediate risk disease like yours are extremely low. If you get any of the most prevalent treatments, you are much more likely to die of something else.
Rest assured that with your intermediate risk cancer you still have quite a few options to explore. The first order of business, however, is to get a second opinion on your biopsy from Bostwick, Epstein or Oppenheimer. They only read prostate cancer slides and it is a very specialized skill.
Your options include SBRT, LDR brachy (seeds)+IMRT and HDR brachy (temporary). At the best facilities, the 5-year freedom from recurrence for intermediate risk are as follows:
LDR Brachy (Dr. Taira) - 97% (12 year - may include ADT and external beam IMRT)
HDR Brachy monotherapy (GammaWest) - 94%
SBRT (8 institutions) - 93%
IMRT (Memorial Sloan Kettering - 86 Gy) - 86% (8 yr)
IMRT (Memorial Sloan Kettering - 81 Gy) - 78% (7 yr)
Prostatectomy (Johns Hopkins) - 77%
Proton (Loma Linda) - 65% (approx)
Pencil-beam Proton (UF Jacksonville) - 99%
In terms of salvage if initial therapy fails, salvage anything will almost always have more side effects than initial therapy. Salvage radiation after surgery will have a worse outcome than if radiation had been done initially. Salvage surgery after radiation is messy, but there are some surgeons who specialize in that. More importantly, salvage after a rare local radiation failure is best handled with more brachytherapy or SBRT rather than salvage surgery. With both SBRT and HDR brachy, the total radiation dose received is only about
40 Gy, which leaves plenty of room to do it all a second time if need be -- more likely, they would do a biopsy and just treat any focal recurrence.
Surgeons almost always recommend surgery -- it's what they know. Radiation oncologists almost always recommend radiation -- it's what they know. Moreover, each sub-specialist (e.g., robotic surgery, seeds) will recommend his sub-specialty. That leaves the burden on you to find out more about
the other therapies. I talked to about
6 doctors before I made my decision. Please let me know if I can answer any questions.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 6 year results
treated 10/2010 at age 57 at UCLA
•PSA since treatment:
1/11:3.9 5/11:3.0 8/11:3.7 5/12:1.2 9/12:1.3 5/13:0.4
• SEs of treatment:
after 2 wks: mild urinary & rectal - last 1 wk
1 yr after: mild urinary - last 2 months