I just wanted to add another voice recommending you slow it down and take your time. It's an important decision, and with your diagnosis, there is little risk in taking your time.
They have a new category for your kind of PC (which may be entirely different from the kinds your brothers had). They call it "favorable intermediate risk." It describes a particularly non-aggressive kind of prostate cancer that is characterized by GS3+4, less than half the cores positive for cancer, and otherwise low risk characteristics. It has almost the same prognosis as low risk prostate cancer, and all the same treatment options - including active surveillance! - are
open to you.
Just because a urologist said "surgery or HDR brachy" doesn't mean those are your only good options. But it is up to you to go out and get opinions from specialists in all of your options, with whatever constraints your insurance puts on you (this is
open enrollment time if you want to switch insurance). I think it is a good idea to decide not to decide until you have gathered all your information.
I know that UAB offers SBRT. It sounds like you have a place that offers HDR brachy monotherapy
. The closest experts that I can recommend for LDR brachy or focal ablation would be in Florida, but I don't know if that would be out of network for your insurance.
Fiducial implants are done through the perineum or through the rectum (like in a biopsy). If your brother had it placed through his penis, his doctor was a sadist.
There are salvage options for any kind of therapy. Salvage after surgery is always radiation. Salvage after radiation is either more brachytherapy, focal ablation, or even whole gland SBRT. With your diagnosis, salvage therapies should be the least of your concerns because the expected outcomes are so good. Not 100%, but close to. In a recent study of SBRT, for example, 97% of intermediate risk men had no evidence of disease after 5 years;and 95% for HDR-BT with 10 years of follow up. In those few cases where the cancer was not controlled, it was due to it already being metastatic, so salvage therapy would be useless anyway./pcnrv.blogspot.com/2016/09/5-year-sbrt-trial-high-cancer-control.html/pcnrv.blogspot.com/2016/08/high-dose-rate-brachytherapy-hdrbt.html
Younger men recover better from every therapy, so I don't see how that makes a difference in your decision. Here are some questions you may want to ask yourself:
• Do I need to see a pathology report to tell me how contained it was?
• If I choose radiation, can I live with the fact that PSA goes down over a number of years, with bounces along the way, and never becomes undetectable?
• If the pathology is adverse and PSA does not become undetectable, am I prepared to undergo adjuvant radiation with all the potential side effects that entails? (Your doctor has hopefully run a nomogram showing the probability of this happening)
• If the radiation doesn't work, am I prepared to have a biopsy and possible focal brachy re-treatment?
• Which bothers me more - the potential for incontinence and ED after surgery or the potential for retention and irritative effects after radiation? (given the probabilities of those side effects)
• Do I understand the other possible side effects of surgery? (e.g., infection, hernia, climacturia, penile shrinkage, stress incontinence, etc.) Am I prepared to take on penile rehab?
• Do I understand the other possible side effects of radiation? (e.g., fatigue, proctitis, hemorrhoids, frequency, urgency, burning while peeing, ED).
• Am I mentally prepared to undergo radiation?
• Am I mentally prepared to undergo surgery and its recovery?
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