Welcome,
If you are comfortable with surgery after looking and considering the other options, then it is the right decision. I'm a surgery guy myself and have no regrets. I knew my personality would not allow another option. Cancer--get it out and get it out now was my attitude. I made sure I had an experienced top notch surgeon and rolled the dice on side effects. I will be 5 years out this February and so far undetectable, no incontinence, and no ED. The good news is that there are a lot of guys just like me out there regardless of your treatment choice. Best of luck to you.

Tom

Before you do anything, get a second opinion on those biopsy slides!

Hello and sorry you have to be part of our club. But as a G7 you should feel confident that every treatment option has an overwhelming chance of curing you.

Choosing a treatment option is very personal and we all have different reasons for choosing our treatment. Surgery has some finality to it...prostate is gone and you can really see what you're dealing with. Radiation--and there are several different techniques--is less invasive, generally has less onerous SEs, but it takes longer to know if it was successful. (Although keep in mind that as a G7, radiation is highly likely to be successful--the same as surgery.)

To your point...you're leaning toward surgery since "radiation may hinder future surgical options." That is 100% true. But it doesn't hinder future *radiation* options. It's a false assumption to think that with surgery you get two chances and with radiation you only get one chance--there's always a back-up option. It's just that if you're talking to a urologist (surgeon) by training, they're always thinking of surgical options...not radiological options. And most important--you probably won't even need a back-up with your diagnosis!

IMHO, knowing that any treatment should cure you I would dig deep into the radiation alternatives. You may like them better, or you might say that you like the finality of surgery. That's your choice. But you only know if you do the work to find that out.

None of this is much fun after getting a cancer diagnosis, but keep in mind that no one cares about your health and any potential SEs as much as you do. At the very least, you have tons of time to decide since PC advances very slowly. There's no right or wrong answer and we'll support you wherever you land. Good luck to you!

Hi mtm and welcome. I am also a newbie (wife) but check my signature for DH's progress - your story is very similar to his. We are still happy with his decision to go for surgery at the tender age of 47. We were able to gain 7 years of side-effect free quality of life. Even though DH's PSA is firing up a little bit now, he will be able to choose (or not choose) a salvage treatment, starting from a great post-operative outcome.

You didn't specify what type of surgery was offered at Duke, but I am assuming it will be Davinci with a surgeon who has done millions of these. The more the better. If you have any specific questions, there are a number of members here who have had that exact procedure. My DH had a picture-perfect experience with a skilled surgeon and has absolutely no regrets. He still chuckles when he remembers seeing the doctor in the corner on a computer-looking thing and thinking,, "what's he doing over there???" haha Recovery is not without its, lets say "learning curve" - but you get through it.

Remember there are also people like me (caregivers) here on the forum who can assist your significant other with their questions as well. My DH is rather shy but other DH's are not.

Picc

Hi, mtm, and welcome to the club none of us wanted to join.

You've gotten a lot of very good advice already. I, too, am new here, and am just a couple of months (yes - months) farther along the path than you. I was told of my diagnosis in early July, and have spent the past two months learning about this disease and its potential treatments.

I'm a bit older than you are (almost 69 now), and have chosen radiation as my first-line treatment. The others are right - you need to see both a surgeon and a radiation oncologist, as each can only speak fully about their own specialty. I did a lot of research and have chosen SBRT (stereotactic body radiation therapy), specifically CyberKnife. This is a relatively new (maybe 8-10 years) type of radiation delivery system that has been found to have very high cure rates, similar to surgery and the best of the traditional radiation systems, with less side effects than the other external radiation methods. We will not, as another poster noted, know about long term side effects that might happen 15-20 years out for another 15-20 years. I'm OK with that, but I was not OK with yet another major surgery for myself. That is something to seriously consider - prostatectomy IS a major surgery. Are you and is your body ready for that?

I agree that typically men in their 50's are advised to consider surgery as first-line treatment, but I work with a man who was 56 when diagnosed and had robotic surgery. When I told him of my choice of CyberKnife, he said that he wished he had been able to choose CK, given what he went through with surgery. He had surgical complications, but is doing fine now 3 years later. His pathology report was too advanced to be accepted at that time for CyberKnife, so surgery it was. These days, CK is approved for even some intermediate risk patients (which is, I believe, what your classification would be, with GS 3+4), so you may actually have a choice available.

The important thing is that you have time to do your research and choose the treatment that you feel is best for you. Medically, with your pathology, any of the standard treatments will "work." Make your decision based upon the side effects of the various options and your ability to live with them over the long haul - and you WILL have a long life to enjoy after treatment.

P.S. I don't want to be "mean" here, but if you were just diagnosed in mid-August, and you have already booked the OR, are you sure you've done all of your due diligence? Admittedly I am a "control freak" but even with all the research I did and consultations I had (one uro surgeon and two radiation oncologists), I just this week made my commitment - and I was diagnosed the first week in July.

MTM,

For research on High Dose Rate brachytherapy (HDRBT) please see www.cetmc.com. This is the website of Dr. Jeffrey Demanes the father of HDR for PCa as well as many other cancers. He has been performing it since 1981 and has published 10 and 15 year results studies. He has been the head of the department at UCLA Medical Center.

I had HDR nearly six years ago and am cancer free (undetectable PSA) and nearly side effect free. The only radiation side effects I have is a lower expression of ejaculate. I have been completely continent, no bowel issues and no ED from the radiation. I also had IMRT so this is a common side effect. Of course with surgery there will be no ejaculate and you have a greater probability of incontinence and ED.

I was treated in Atlanta and we have two excellent centers that specialize in HDR in Atlanta. I do not know if Duke offers it.

Hello MTM and welcome. Sorry you have to be here. Unfortunately your situation is typical of hundreds of guys who have arrived here, i.e. they have met with a urologist (surgeon) and decided to have surgery before doing full due diligence on our disease. I have several points to make below but the main one now is to take a deep breath, take your time and do your homework before making a potentially life changing decision.

OK, here are my suggestions:

1. Get educated on our disease. A good starting place is the sticky thread at the top of our forum that is designed for new patients. Then consider reading Dr. Walsh's, "Guide to Surviving Prostate Cancer" and Dr. Scholz', "Invasion of the Prostate Snatchers".

2. Get your biopsy slides sent off to a real expert, i.e. Dr. Epstein at JHU or Bostwick Labs. Reading prostate biopsy slides is an art; those experts listed are the artists you should contact.

3. Don't be fooled by the red herring about backup options after a failed surgery. As others indicated there are excellent backup options after a failed radiation as well. Hopefully the original treatment will not fail. But if it does, you have good options either way. This is not a reason to choose one treatment over another.

4. Given your stats, most of the treatments should cure you. Besides considering surgery, you would be smart to seek out experts in HDR Brachy, LDR Brachy and SBRT. All of these three are equally as curative as surgery but less invasive and with a lower likelihood of onerous side effects like ED or incontinence.

5. Don't be scared by the low percentage sides effects of any treatment. Some surgery patients die on the table. Some radiation patients have long term bowel issues. These percentages are small; focus on the BIG deal side effects of ED and incontinence.

6. Here is the way I look at the primary value propositions. Surgery gives you some immediate knowledge of your exact pathology and the psychological value of "having it out". Radiation gives you a better chance of avoiding ED and incontinence.

I am admittedly biased toward radiation and if you read my story in my signature you will see why. I have seen way too many sad stories of post-surgical heartbreak during my 8 years on this forum to think that surgery is a good choice in very many situations. But hey, that's me and my bias - you need to do your homework and make an educated decision.

Best of luck,

Jim

MTM....welcome ...you`ve heard from some of the experts.....think about it .....David

Thank you guys for some excellent things to consider. The combined knowledge of this forum is amazing. I'm lucky to have an loving wife to help me with this - I know this will be a decision that effects both of us for the rest of our lives.

To answer a couple of questions - 3 of 12 biopsy samples were positive - 2 of 2 at right base and 1 of 2 at right apex. Duke was my second opinion, but I will definitely get the slides sent for an expert analysis.

Right now, I am of the mindset of getting it out and not letting it spread. I hope to live for many more years and would rather know that it is out and wont come back, but you've given me great thoughts on many other options to consider. My father is a survivor and had radiation and HT, but he was almost 70 when diagnosed.

I guess I'm a member of this forum for life - Hope to learn and contribute a lot! I know that the right positive attitude can make all the differences in the world - thank you for helping us overwhelmed newbies feel this is something we can handle!

mtm: listen to Mr. TA. He knows of what he speaks. PC, perhaps alone among cancers, gives the patient the opportunity to think it through and make considered decisions. We'd continually suggest you make use of that time. Do the research, seek multiple opinions from experts in every treatment modality before you pull the trigger.

You're 55. You have a LOT of healthy, productive years ahead of you. Make sure you consider the potential side effects. In my signature below is a link to "my story". Others in here have similar links set up. Read a few of them.

I was your age when diagnosed. I went for surgery. I have had a great outcome. Not everyone is so lucky. We've had many threads and many surgical patients who had poor outcomes from a side effect quality of life standpoint. I'll say it again: you owe it to yourself, and your wife, to truly consider all the options.