J, there ya go. Now to the work of getting information and figuring out YOUR treatment plan. With 7/12 positives, PNI, and that one 4+3 (have you had your slides sent for 2nd opinion?), you're in the group that (a) needs treatment and (b) is likely cureable by any of the typical treatments.
It comes down to how your head works, and what is important to you. Here is my condensed view of the options:
Surgery (Robotic or
Advantages: Really, outcomes are similar, it all depends on the individual skill of the surgeon, so pick one who has done a lot and is willing to share his individual outcome records with you.
To me, the advantages of surgery (and I'm a surgery guy) are (a) you know within a few days what your true pathology is. (b) You have the advantage of a rapid, usually within 3 months, PSA drop to nil. (c) You have 1 24-48 hour hospital stay, followed by a few weeks of convalescence at home. Yes, it's major surgery, and it takes it's physical toll, but it's done and over in a few weeks or months.
Disadvantages of Surgery: Depending on your surgeon's skill, the individual surgical trauma you sustain, and "luck", you stand a reasonable chance of developing temporary or permanent incontinence and ED. How that plays out is all over the map. A lot of it seems to depend on whether you have any, and they mean ANY issues along those lines pre-surgery. Also, the level of nerve removal needed in surgery, and possibly the variables of your anatomy compared to others.
Also, it appears from comments in this forum, variabilities in the level of physical activity you engage in daily seems to have both a positive and occasional negative effect on incontinence in particular.
Radiation: it comes in several flavors, with the two main subdivisions being external beam types and brachytherapy (seed placement)
Here again is my take: You'll find in this forum a lot of adamant 'radiation is way better than surgery' folks here, a lot more than you'll find that are adamant that 'surgery is way better than radiation' guys.
That being said, the way I saw it..and still see it today goes like this:
The external beam types (and SBRT is a hybrid between brachy and external), take a number of visits for treatment, varying from a handful (usually 5) for SBRT, to up to several dozen for EBRT. So, if you can easily get to and from the treatment center, that's one thing. If you (like me) would have an all day round trip for each treatment event, that can be a whole 'nother thing.
Brachytherapy involved inserting 'seeds' or radiation pellets into the prostate and letting it radiate from the inside out.
Radiation advantages: Less invasive than surgery, usually relatively short treatment visits (a few minutes up to a few hours). Overnight hospitalization is rare. Immediate side effects are minimal (lots of naps are commonly reported) Many brachytherapy patients in particular report 'no biggie': they go in a couple of times to plan the placement then get them placed and that's it.
Radiation disadvantages: It takes a while for it to take effect. The radiation protocols talk about
PSA nadir, and it is monitored for quite a while until it bottoms out, which can take several months or longer. Also, you'll never know your 'true' pathology. For many, that's not a big deal. For some, it is a huge reason to not do radiation. The long term side effects are a challenge. There is some research out there that suggests (not proves conclusively) that the 10-20 year out side effects of radiation can be a serious issue. Both from collateral damage to the rectum and other pelvic body parts, and the development of other urinary tract issues, including ED, incontinence, bladder problems, etc, often long into the future.
These are risks...how high? Hard to say. But it is information to weigh.
Age at Diagnosis: 56
Biopsy: 3 of 12, G3+3, all on LT side, 20%, 5%, 3%
Clinical Stage T2C
Bone Scan, CT scan negative for spread
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA 3/10/15: 0.10
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024