Welcome. Since this is a forum where we can give our own beliefs and feelings about
the disease and it's treatment, here is mine. It reflects only my reasoning about
this with the information I had 6 months ago when I was making my decisions.
We seem to have similar stats, sort of. My top Gleason was 4+3, from a biopsy sample that was 40% tumor. I chose DaVinci robotic surgery because of the precision with which the doctor could dissect the gland and sew the urethra back to the bladder. I had read some reports that the robotic surgery has equal outcomes to the
open surgery. My doctor gave me a quote of a 91% cure rate with the surgery, but only a 75% cure rate with any kind of radiation or the cryotherapy (and since it is like the cryotherapy in the way it gets the prostate out, the HIFU). These stats for radiation were different than what is usually reported --that radiation is equivalent to surgery. This equivalency may be correct and derived from updated stats, but I got my information only last June when I got diagnosed. But, 91 vs. 75 was a no-brainer for me.
I would definitely read at least Scardino's and Walsh's books. The take-home lessons I got from these led me to think that I would rather save the radiation as a salvage treatment, if the operation failed. With the gland, seminal vesicles, and lymph nodes removed, you know more about
what you are dealing with. I am 57, a worrier, not a gambler, and have teen age kids. I did not feel comfortable trusting that the radiation would get everything. I wanted the beast out of me.
Also remember that what the biopsy says is sometimes an underestimation of what is really going on down there. Please read Hawkfan's recent thread about
his post surgical pathology report. He would not have known about
the extension of the tumor had he had beam radiation or seeds. Also, from the books I read, radiation doesn't necessarily spare you from having urinary problems, erectile dysfunction, or even bowel problems. The radiation may affect the nerves that control these, but the changes may come on slowly over time. As it was, one of my erectile nerves could not be completely spared, and the doctor was able to do a nerve graft during the robotic procedure. With regard to urinary continence, I would say I'm 98% recovered right now at 5 months out. With regard to Mr.Happy, I'm dead in the water right now, even with pills and penile suppositories (haven't tried the shots yet), but, again, it's only five months and most say not to expect any substantial return for 8 mos to a year.
As everyone says, you've got to do what's meaningful and comfortable for you, but, in my book, when they offer surgery to you, that means they think they can cure you.
Just some thoughts.
The best to you as you make these tough decisions. Please stay with us, and keep us posted.
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).