Posted 2/3/2015 10:32 PM (GMT -7)
Firstly, I decided on surgery because of my Gleason 9. Being able to get an accurate Gleason, and knowing if it was contained seemed to be important to me. Surgery is the only way to get a conclusive pathology. Surgeons are fairly easy to evaluate. Number of robotic surgeries, any malpractice claims, PSA levels of patients at 3 months, etc. Like you going to Duke, I chose Cleveland Clinic, so the head of the department, or some other auspicious title makes a guy feel good.
RO's are a little harder to evaluate, and again with Gleason 9, it is even harder. Being nice guys with plesant personalities are nice, but may not matter. Also, the RO usually doesn't actually do the work for IMRT or IGRT. The radiation tech is a key figure.
Surgery gave me 3 years of good results. Low PSA, few SE's, but not negligible. After watching a slow trend of increasing PSA from <.01, to .06, I decided to do IGRT. It too has given me 3 good years. Hoping for a couple more years at least.
I have concluded that a Gleason 9 is probably not curable. Seems that it will resurface again in many cases. So, if I can get 6 or 7 years with surgery, and IGRT, I wilk feel successful. Who knows, may get 10 years.
Then I will move on to chemo, or Ht, or chemo and Ht. Have seen some great advances since my surgery. Provenge, Xtandi, etc, all seem to be doing some great things. Combo therapies are also making great strides.
Just wanted to give my rationale, but as has been said, all treatments are real close in successful treatments. I just think it is important to pick one, go for it, and NEVER LOOK BACK. Dont let anyone try to convince you should have done something else. Find a doctor or team you can trust, and let them help you.
Good luck to you. Odds are in your favor.