Hi Alan from Allen,
It may give you some comfort to know that many doctors now advocate careful watching (active surveillance) until the Gleason score reaches 4+3. It is likely that you didn't miss any opportunities by waiting. You also have time to decide - this cancer is typically slow growing and waiting more than 3 months to make a carefully weighed decision is not a bad idea, and may be a good idea. There's a shock that interferes with rational decision making that seems to lessen over time.
Here are some therapies that are likely to be curative based on what you know now:
• surgery (
open or robotic)
• High Dose Rate brachytherapy (temporary implants)
• Low Dose Rate brachytherapy (seeds) probably combined with external beam therapy
Lower on the list because of inferiority to those above on the basis of cost and convenience and with no better outcomes would be proton therapy and conventional IMRT (hypofractionated IMRT is a better idea).
Now, here's the kicker - it's not like you can go to any one doctor and get the true low down on any of those therapies. Every specialist thinks his specialty is the best (or else why would he be doing it?), and may think all other therapies are inferior. You have to seek out and meet with expert practitioners of each
of those therapies, and then make up your own mind about
which is right for you
. It's a process that takes time and patience, but at the end, I think you will feel really good about
the decision you make, and proud of yourself for the effort you've made on your own behalf. (I met with 6 specialists myself)
In Michigan, the U of Michigan is very highly regarded for prostate cancer, and I'm sure there are excellent surgeons there who have done thousands, not just hundreds, of prostatectomies. Henry Ford in Detroit is excellent as well. You also have Alvaro Martinez not too far away in Detroit who is one of the world experts in HDR brachytherapy. Farther afield, in Chicago, you have Brian Moran, an expert in LDR brachytherapy; and Arica Hirsch for SBRT.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results
•SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.2,no lasting urinary, rectal or sexual SEsmy PC blog