Prostate Cancer Community

First, never accept it as a fact that the cancer is confined to the prostate..That "finding" is more educated guesswork than anything else..Bone scans and MRI's can not detect PC until it's well advanced..There are several good books that deal with PC, Dr. Walsh's "Guide to surviving Prostate Cancer" is one of the best.. There are others that favor treatment other than surgery, but surgery sets the standard of survival that all the other treatments try to achieve...For many men, radiation is the best choice, but for you, as your doctor said, surgery offers the best path..You are considered fairly low risk, so surgery offers you a good chance of a cure. Impotence is a common side-effect of surgery, incontinence less so, but these are important issues you need to consider..You choice of surgeons is very important... experience and skill matters...With radiation, the initial side effects tend to be less pronounced..But as time goes on, they can manifest themselves in unpleasant ways...Should radiation fail to cure you, surgery is no longer an option and a cure is now impossible...This is just my layman's opinion..

So read a book or two, learn all you can and make your choice..You might find the healingwell.com, prostate cancer board helpful in sorting this out..

Best of luck to you..

My Gleason was the same as yours, and my PSA was 8.5 when I heard about proton therapy. I investigated further and decided that it was the best choice for me. I talked to several others who had been through it and they all were enthusiastic about it. I had my treatment almost 2 years ago, had no side effects, and am enjoying the same life that I had previously. I've heard from many others who are glad that they chose proton. I agree with the above writer that you should learn all you can before making your choice. I've also talked to the men in my prostate support group who had surgery, and they all had incontinence and impotence for various lengths of time afterward.

It would have been more helpful if the doctor had discussed, even briefly, the pros and cons of various treatment options. It is difficult, and risky in terms of terrible side effects, to do surgery after radiation, but if your PSA rose after radiation there's no guarantee the cancer would still be curable by radiation anyway. Not to say that you shouldn't take the "radiation makes surgery risky and difficult" argument into account when making your decision, but consider the "pro" side to radiation as well. And it's considerable.

The "pro" to radiation? It ain't surgery. Don't underestimate how major of an operation a prostatectomy is, even if done robotically. I've had both, and believe me, radiation treatments are about the easiest medical procedure to undergo. Cons? Well, the one we just discussed, plus the fact it's not free from side effects--bowel irritation, ED, bladder irritation--or even more serious injury.

There are pros and cons to every treatment option.

Surgery seems to offer an edge in cancer control in the long run, but as I understand it this generally means men who are relatively young patients (in their 50's). In the shorter run, surgery and radiation (external or seeds) have comparable outcomes, according to Walsh. As noted, you can have followup radiation if needed after surgery to mop up stray cancer cells if needed. You get the (not-to-be-underestimated) psychological benefit of "getting it out".

Like the others, I urge you to take the time to read. I really like Walsh's book. He's a surgeon, but he doesn't advocate it for every patient.

If protons are feasible given your situation and location, I would carefully consider that option, as well as plain old external beam radiation, brachytherapy (seeds), combining brachy and seeds, etc. Protons are famous amongst many men who have had that treatment for being low or non-existent in side effects, but it's still not free of the risk of side effects.

You can start by scanning some books, articles, and websites, and then followup by consulting doctors who practice the various treatment modalities.

Don't rush--this is an important decision. Your big chance to knock one out of the ballpark.

Best wishes.

I just celebrated my robotic prostatectomy 3 week anniversary on Tuesday of this week. I just turned 60 in early December and my PSA was 3.5 and my Gleason score was 6 before my surgery. There was an 88% probability the cancer was contained in my prostrate and the pathology results that came back a week after my surgery of tissue around the prostrate and lymph nodes was all negative. After 3 different doctor's recommendations and much study on my part I concurred with them that robotic surgery was my best option for the best probability of removing the cancer and being done with it once and for all. Neither side of my families have ever had any cancer and I never thought I would. If it wasn't for my GP doctor I would still have the cancer growing and not have a clue since I had no symptoms other than the PSA score from test he ran on me just due to my age. There weren't any problems or symptoms for me. I still have to regain complete bladder control and erectile function. But the doctors have assured me both functions will be able to be restored with time and with various methods. I highly recommend the robotic surgery as the best option for similar situations as mine. As another posting stated, I recommend you get the absolute best surgeon. Experience does matter with this procedure. I go back to my surgeon in 3 more weeks and look forward to getting my PSA score, which we hope and pray will be almost immeasurable. After that it will be yearly PSA test to confirm I'm cancer free.

Regardless of what you decide is best for you I wish you the best and complete healing. Hang in there and beat the big C!