UPDATE - 40, 3.9 PSA with family history

This reminds me of a conversation that I had over five years ago with my urologist. He was (as I recall) the third uro that I interviewed and was the one I ultimately selected; he assisted with my brachytherapy and managed my post-procedure follow up along with my RO.

My wife was deep into the "get it out" mode and he asked us to apply logic to whatever choice we made. His emphasis was that a patient can "get it out", "burn it out" or "wait it out", but that a person should have sound reasoning ("fantastic reasons" per davidg) for making the final decision. He pretty much forced us to answer the question "why" one of those choices was the correct one for us.

For example, "get it out" might be logical if one is prepared to undergo adjuvant treatment upon learning about an unfavorable post-op pathology. Otherwise the patient is simply observing PSA changes - much like a radiation or AS patient. Or, perhaps the patient is very young and simply does not believe that radiation is effective for another 40 years. Or, perhaps the patient just cannot psychologically handle the idea of a dying prostate existing inside their body. Or, perhaps sexual activity is not a big issue. Etc.

In any case, his advice was to have the initial goal of "curing the cancer" rather than pre-determining what that cure should be. He believed that forced logical reasoning as his patients made their decisions.

I think that's why most of us on this forum recommend that patients discuss their cancers with multiple practitioners of different disciplines so that educated, reasonable and logical decisions can be made. Regardless of the final choice, taking the time to get educated and forcing oneself to logically examine the reasons for choosing a particular path seems like a reasonable approach to me.

Jim

Good Evening Keane, 4 years ago I was pretty well in the same boat as you are today. I was a dx at 44, I too have a family history of prostate cancer with my father and two of his brothers having PC (one brother has passed away due to PC). I considered all option available to me and decided the best for me and my family would be surgery. In the end I figured it would be my best bet to rid myself of PC for the rest of my life, I did not want PC to be on my mind for the some remaining 40 year of my life. Things have worked out great for me and and I hardly think of prostate cancer anymore, I used to check this forum on a daily basis for about a year after surgery, but now only visit once in a blue moon.

In no way am I trying to make a decision for you, there are plenty of people on this site that are much more educated on PC that I am, the only thing I am doing is telling you my story. You can find all sorts of studies and books debating all sides of PC, one thing to keep in mind is the studies do not give a black or white answer, what I did when doing my research is I tried to figure out is where I personally fit in the grey area of the studies base on my age, gleason, psa, family history and side affects.

I wish you the best of luck in your journey

Lotsahope, your reasons coincide with mine, with the addition of having young kids and having watched my father die of the disease. I just can't imagine myself doing anything also than having the RALP, and frankly I feel feel a strong sense of obligation to do it. My doctor went to one of the top med schools in the country, trained at Johns Hopkins for these surgeries, and is now practicing at one of the top hospitals in the country with the latest tech. I feel very comfortable with him and his abilities. Obviously, there are strong opinions with respect to treatment, which is understandable. I also can't argue with being open minded and exploring options and getting second opinions. But, at this point the RALP is what I feel strongly is right for me and my family, so that is the direction I am headed.

Keane,
Your reasons are very good reasons and understandable. My only suggestion was going to be to get the best surgeon possible, with thousands of surgeries under their belt. You get one shot at this, make it the best. You deserve it. With an excellent surgeon, you should have excellent outcomes. It sounds like you feel you have found one.
Best of luck!