May I add my welcome to you, also. As the others say, sorry you had to join us, but this is a very informative and supportive network. I want to add my "me, too" to the posting of Tamu, an old friend of mine, as I came to find out. As you may see from my "signature" below, my clinical stats at the start of the journey for me were not so different from you, except that your "tip-off" PSA was a bit higher than mine, but my Gleason was worse, and the size of the largest area of cancer in one of the samples was 40%. At three months, after my robotic surgery, my PSA was < 0.008, so as of now, I am a satisfied customer of the robot.
This whole prostate cancer thing is such a crapshoot. On my first follow-up visit after the biopsy, when we were making plans about what I should do, my doctor gave me the odds of cure with the different treatment modalities. Surgery of either kind (open or robot) was 91%, any external beam radiation and brachytherapy were 75%, as was cryosurgery (75%). He did not mention HIFU because it was not done in this country at that point (4 months ago), and I don't know if it is here yet. I would bet that it has the same cure rate as cryotherapy, because they are somewhat alike (with HIFU you cook the gland and dissolve it so it can be sucked out of the body, and with cryotherapy you freeze and then thaw it and extract it similarly).
I am a worrier, and was relatively young at the time (56), and91% vs. 75% was a slam dunk for me. Read Dr. Walsh's book on surviving PCa or Dr. Peter Scardino's book The Prostate Book. Admittedly, they are both surgeons and might have a bias towards cutting the problem out. However, I have been told that prostate cancer is such a thing that you cannot just take out the bad part and expect to be cured. The entire thing has to come out, or remaining normal cells may give rise to malignant ones. That is why when they remove the prostate, they even shave off part of the bladder neck, as well, because they don't want one prostate cell remaining that could go bad. Additionally, only prostate cells make PSA, and the way they currently tell if one is cancer-free is to have a PSA less than 0.1. If any cells are remaining, they will make PSA which will confuse the issue on if and how much cancer remains. The modalities other than radical surgery do not get all of the cells.
The books give the probabilities of side effects with all the treatments. With surgery, your side effects are up front -- incontinence and erectile dysfunction. I was about 95% continent two days after the catheter came out; the other matter is another matter. I had nerve involvement on one side, and the doctor did a plastic surgery on it so that there would be chance after several months that I could get function back. With any form of radiation, I believe that these side effects can come on little by little over time, because the radiation is not going to be confined to the capsule. It can injure the nerves controlling continence and erections over time, and thus one may be no better off in those regards. Additionally, the radiation may injure the colon in that area, with consequences for bowel function. Like Tamu and the lay counsellor that I talked to said, you can have surgery and then radiation (if necessary), but you rarely have the chance to have radiation and then surgery. Not only does the radiation make the tissue to be operated on fragile, but in the case that surgery is needed (the cancer got out after the radiation effects failed to limit it), many doctors do not like to operate for cancer extended outside of the gland.
Another part of the crapshoot is that the biopsy may not tell the whole story. My clinical stage was T1c (cancer found by biopsy only, but confined to the capsule), and the biopsy revealed cancer on only one side with no neurovascular bundle invasion. Only two months later, after the surgey, my final surgical pathology report gave a stage of T2c, cancer on both sides of the gland, with "definite neurovascular bundle invasion." The neurovascular bundle is the route for badness to get out of Pandora's box. They wouldn't have known about this if it hadn't been taken out and looked at. Nevertheless, the rest of the report said negative surgical margins, negative lymph nodes, and negative seminal vesicle involvement (all good prognostic signs that, again, one wouldn't know anything about unless they were taken out in surgery).
For my money, I would also consider surgery, in addition to the options you mentioned. In prostate cancer, it is a good sign if they offer you surgery (that means it can be cured). And if one is going to have surgery, robotic surgery is something to ask for. It is not just a case of losing less blood, or having less trauma, or your belly looking nicer afterwards, or going back to work sooner. The new techniques associated with it allow better visibility of the area-- the viewer is a 3-D microscope-- and, if the doc is very experienced at it, the feel is just as good as open. My doc told me that with the smaller size instruments and better control of them, he can make a continuous suturing around the free end of the urethra (that is left after taking out the section that goes through the prostate) as it is attached to the newly made bladder neck. He told me there would only be room to do about six sutures around this tube the old way. The particulars of who does it in your area, and all the stuff that it can do, are on their website www.davinciprostatectomy.com. I am not a stockholder in Intuitive Surgical, the people who make the thing, so I am hopefully not afoul of the code of ethics for this website. I am just a happy customer.
A thing about prostate cancer that is so weird is that all these highly educated and experienced specialists leave the strategizing and decision making to the average man. That's what makes these forums so important, in order to get others' experiences and outcomes.
Just a thought, and
All the best,
PSA (10/04): 2.9; PSA (2/06):4.4, on Androgel (serum T about 450) at age 56; negative DRE, no symptoms.
PSA (5/06):5.7 with a free PSA% of 8, OFF Androgel (serum T 163).
Biopsy (5/06): 4/12 samples positive; postitive samples only on right side; max Gleason 4+3=7 (in 2 of the 4 -from area nearest bladder.
DaVinci robotic-assisted laparoscopic radical prostatectomy + bladder lift + Right nerve plastic surgery (8/23/06).
Catheter out 4 weeks postop, due to internal pinhole leak at bladder-urethra junction.
Final pathology report:T2c-both sides,but in capsule; neg. margins, neg. lymph nodes, neg. seminal vesicles; final max Gleason still 4+3=7.
Follow-up PSA (11/06): <0.008; serum T: 195 OFF Androgel (at present).