my psa started rising about
five years ago.. 1.4, 2.8, 3.2, 4.5, 6.5, 7.5, 8.8, 9.3
Paternal history as well, so there's that.
It was only when it hit 4.5 that we started looking and doing biospys. Two total, one 12/2014 and another 12/2015 (after PSA continuing to rise and free psa BAD and PCA3 negative. Since it was anterior apex it was harder to get to but certainly doable through the back entry port. I'd prefer that to a through the scrotum or otherwise.
By 1/2016 I was meeting with oncologist, surgeons and radiation specialists around the country.
Of the seven people in total I met with, 6 of 7 said surgery was the best option for healthy, young man, looking for absolute cure and high expectation of high quality of life. Everyone, even the RT specialists said either "your're better off with surgery at this stage" or "you'll do best with surgery"
The simple summary for this stage with containment and young healthy patient is, surgery MAY have some very low probability limited downsides in the hands of a skilled surgeon but it's essentially a 100% cure rate at this stage and after recovery there shouldn't be any impact.
(well, no ejaculate means no making babies naturally so think about
that - and store some sperm or get ready to harvest sperm from the testes)
Whereas radiation, while having a high cure rate of course as well EBRT, BT, SPRT, even proton there are most likely going to be some downsides in various areas of varying degrees and, nearly to a man (yes, they were all men except for the copilot on my actual surgery) they said "we just don't like recommending radiation for a young man with arguably 4-5 decades of life ahead unless something about
location, possible metastasis or preference of the patient dictates it.
And then the old adage is that once one does Radiation, doing surgery after (pretty rare but it happens) is less of an option and what they call a "salvage" procedure, and the downsides are much greater than had surgery been done initially.
BT and other RT therapies CAN be cheaper than a RALP for sure. sometimes half to 40% of the total cost. But, if you're insured you're probably looking at some sort of annual OOPM regardless.
If you want me to, I can email you all the restricted research reports I collected (I had a medical researcher assigned to me at Stanford at first who did any research I asked for and had access to normally unavailable clinical trial reports and research reports) that helped guide my thinking and analysis.
Post Edited (paulmerc) : 10/1/2016 2:50:30 PM (GMT-6)