I feel like I've been on a roller coaster, deciding what treatment to go for. First it was going to be seeds, then da vinci robot, and now all of a sudden I'm reading very positive things about
proton/ photon treatment at Loma Linda.
Best I can figure it, the pros and cons shake out like this:
1. Brachytherapy: Pro's, it is fairly quick. Treatment performed on an outpatient basis. Few side effects at first. Temporary side effects while the seeds are working. Long term prognosis for cancer recurrence, if performed by a top-flight team, are about as good as any other form of treatment, though there are not yet any longitudinal studies extending beyond about 20 years.
Cons: incontinence and ED can emerge as side effects after several years have passed. Basic non-surgical treatment of either is the same as it always is, kegels, viagra and pumps, etc.
2. Da Vinci: Pro's, you get the whole prostate out so it can be evaluated closely, agressiveness of tumor accurately gauged, risk of micro-metasteses evaluated. Surgery has always been considered the gold standard, because it has been around so long and the survival statistics well documented. Da vinci, if performed by a top doc, has lower rates of incontinence and ED than open, if the open is performed by an "average" surgeon. For top-flight surgeons, the side effects of open surgery can be statistically be about the same as da vinci. Another pro, is recovery time is quicker than with an open. Also, if you have incontinence and ED, you'll know it pretty quick and can work towards improvement sooner. Probability of nonrecurrence is around 90% or so, right? Con's: recovery takes from two weeks to two months, though some guys remain incontinent longer, though that is less likely with a top doc.
3. Proton/photon: Pro's, well, it seems to work quite well. On protonbob i have not read about incontinence or ED. Do these not happen with proton/photon? I'm not clear.
Con's: It takes two months for the treatment. I do not know what the recurrence rate statistic is.
Questions: Does anybody know about the side effects of proton beam? Is there little or no risk of incontinence or ED? Is there a risk that these can emerge later, as they do with seeds?
Thanks for any input anyone can provide. My pro's and con's are not exhaustive, and are really taken off the top of my head this afternoon.
I'd like to read your thoughts.