Welcome to HW. Sorry you have to be here but I'm sure you have found already that there are lots of caring folks here who are happy to provide support and advice.
The first thing I would suggest to you is to take your time in making your decision. Prostate cancer is typically a slow growing cancer and please don't get rushed into a treatment choice. You get one chance to do this right the first time, it's a potentially life changing decision and you want to have confidence in your choice. You should make sure you get educated on our disease. A great place to start is the "sticky" thread at the top of our forum that is designed for newly diagnosed patients: https://www.healingwell.com/community/default.aspx?f=35&m=2652250. There are also some great books that I would highly recommend. My three favorites are, "Guide to Surviving Prostate Cancer" by Dr. Walsh, "Invasion of the Prostate Snatchers" by Dr. Scholz and "A Primer on Prostate Cancer" by Dr. Strum. Another excellent resource is the NCCN guidelines for patients: http://www.nccn.org/patients/guidelines/prostate/#1.
Reading biopsy pathology is as much art as science. It's always a good idea to get a second opinion on your biopsy slides from one of the acknowledged experts in prostate cancer pathology, e.g. Dr. Epstein of JHU or Dr. Bostwick of Bostwick Labs. You can find instructions on their web sites. It is critical to make sure you know what you are dealing with and is worth the time and trouble to get this second opinion.
Before choosing a treatment you should make sure that your cancer is properly evaluated and staged. A fairly new tool, the multi-parametric MRI is extremely useful for this purpose as is color doppler imaging. If your urologist is not familiar with or comfortable with these tools then it's time to seek another doctor.
Depending on the results of your second biopsy pathology opinion, your cancer may be very early intermediate stage; if so Active Surveillance should be examined as one of your alternatives. Some programs are accepting G3+4 patients. (However some programs are still restricted to G6 patients). There is a good chance that your cancer will not harm you and, even if it does progress, studies have shown that treatment is likely to be just as effective "then" as it is "now". However, you need to make sure that you are being seen by a doctor/program with experience in AS so that you are staged and monitored properly from day one. Today's AS is not your father's Watchful Waiting.
If your cancer is contained, then it is likely that any of the major treatments will cure you. Surgery has the advantage of providing immediate knowledge of post procedure pathology and gives patients who need it the psychological satisfaction of "getting it out" of their bodies. However surgery also generally yields the most onerous side effects including immediate incontinence with a small chance of permanent incontinence as well as a 50% chance of permanent erectile dysfunction. It may also leave the patient with a smaller penis and the chance of ejaculating urine.
There are various forms of radiation that generally provide cure rates equal to surgery but with less onerous side effects. LDR Brachytherapy, HDR Brachytherapy, SBRT, IMRT and PBT have all shown excellent results. There is generally minor urgency and frequency or urination, a small chance of bowel effects and. on average, about
a 35% chance of permanent erectile dysfunction.
The oft repeated mantra that "saving" radiation for a backup plan is somewhat suspect logic, IMHO. If the cancer is contained in the capsule then either surgery or radiation will provide a cure. Radiation will also treat the areas just outside of the capsule for any little buggers who have barely escaped. If salvage treatment is needed after failed surgery, then radiation is available. If salvage treatment is needed after radiation then I personally think that surgery, while possible, is problematical. However, what some surgeons fail to mention is that if savage treatment after failed radiation is needed then there are many salvage options available that are equally effective to the salvage options offered after a failed surgery.
In any case, there are multiple studies that show that the experience of the doctor performing the treatment is VERY IMPORTANT...both in cure rates and in reduction of side effects. Experience matters and I wouldn't choose any physician for any treatment whose experience wasn't at least several hundred procedures.
At the end of the day, the final treatment choice is a very personal decision. Some doctors will push; some friends and relatives will push. But, IMHO, the best approach is for a patient to become educated, get properly tested, evaluate the alternatives in a logical fashion and then make the best decision possible after becoming armed with the appropriate background.
Good luck and please keep us up to date on your progress.
Forum Moderator-Prostate Cancer. Age 62 (66 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Everything continues to function normally as of 7/13/13. PSA: 6 mo: 1.4, 1 yr: 1.0, 2 yr: .8, 3 yr: .5, 4 yr: .2. My docs are "delighted"! My journey:
Post Edited (Tudpock18) : 4/17/2014 2:57:30 PM (GMT-6)