Let me add my congratulations on being able to see Dr. Scardino. He is one of the top cancer urologists in the country. He was chair of the Dept. of Urology at Baylor here in Houston, and then went to MSK. He recruited my doctor to Baylor when he was building his team here, and I really like my doc. But, you have a chance to see The Man!
There are, in my opinion, two books that any guy (and his mate) should read (buy or check out from the library) who has PCa. One is Dr. Walsh's book on surviving prostate cancer. The other is Dr. Scardino's Prostate Book. If you can get this before you go see him, try to. Dr. Scardino's book was one of the most hope-inspiring things I got my hands on before and after my surgery (especially the section on survival).
I had a somewhat similar case to yours, except that the biopsy didn't show neurovascular bundle invasion, but the post op pathology did, and my Gleason was a bit worse (4+3=7). Nevertheless, I believe surgery is the best way to go, at first, even if there is some advancement. A guy who counseled me at the beginning of my situation told me you can have surgery then radiation, but you can't have radiation then surgery (at least not in most cases). Sometimes, after prostatectomy, if the PSA starts going up again, they have to do supplemental radiation, but you don't have the prostate in, still being the source of cancer to ship elsewhere, and causing obstruction of urinary output as it grows in the capsule. I wanted as much of the cancer out as possible, and radical surgery seemed to me a way to get everything out that you can see. With my situation, they gave me a 91% potential cure rate with surgery, and 75% with any kind of radiation - - external beam or seeds. I was lucky to qualify for the robotic procedure, which has about
the same percentage potential cure rate, and produces less wear and tear on the body. This to me was a no brainer, but everyone is different. Please keep us posted on how it's going.
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).