I have gleason 9. PSA about
10. Bone scan suggests no spread.
After 4 consultations, I decided to go with SBRT / CyberKnife (5 sessions in 1 week) + hormone deprivation (2 months before SBRT followed by 6 months after.). I started the hormone deprivation 3 weeks ago.
The first consultation was with the head of urology at Columbia P&S. Usually people expect urologists who are surgeons to recommend prostatectomy. He recommended SBRT with no hormone deprivation. He sent me to 2 radiation oncologists. Winthrop & Columbia. One recommended: 2 months hormone deprivation, 9 weeks of IMRT radiation & then 2 more years of hormone deprivation. I went with the Winthrop recommendation. As far as I can tell from reviewing long term studies, the CyberKnife therapy has outcomes as good as the other treatments and has the big advantage of shorter treatments and fewer side effects.
The latest long term studies with CyberKnife shows that hormone deprivation does not improve outcomes for high risk. I decided to go with it anyway as a precaution. Also, the CyberKnife studies show biological failure seems correlated with high PSA (not me) and not with high Gleason.
You might want to read the thread I started.www.healingwell.com/community/default.aspx?f=35&m=3783232
You will find references there to long term outcome studies.
Remember that the sample sizes in the long term studies for high risk patients (high Gleason & high PSA) are often very small (100 or so) and therefore less decisive. Most prostate cancer patients are not high risk.
I think that you will find that most of the treatments have similar outcomes. But, some of the treatments have more aggressive side effects. Remember also that with prostatectomy your sex life will change. Orgasm is usually still possible, but ejaculations disappear completely. Surgeons usually forget to tell you about
the ejactulation issue. Hormone deprivation also usually has unhappy side effects: memory loss, weight gain, reduced sex life, etc. The longer the hormone deprivation, the more side effects. Most people seem to say that your body will recover from hormone deprivation in approximately the same time as you were on it.