Hab, if there is one thing I feel fairly certain about
is that, with the
KNOWN facts, you have time to figure out the best approach from 3(or more) approaches: AS(watch it closely), surgery or various forms of radiation.
DO NOT allow any surgeon or any one else to rush you into a decision that might well have life altering implications. There is no going back from whatever you have after you leave the surgery room. Or for that matter RT. Both have permanent effects on your body, though primary RT might have less severe SEs if every thing goes right, and most certainly is less likely to have immediate bad SEs(but no guarantees, just ask Purgatory). If you are going to get a suck ass SE, would you rather have it right now, or wait a few years?
Above all else, I suggest you find a couple of physician opinions, from some one who is not going to profit or suffer loss from your decision. And one thing you want to find out from them are the actual odds of you ever dieing from low volume G6 PC even if you do nothing, and then after that if you have seeds or other primary RT or surgery. Find out what these odds are compared to your odds of dieing from heart attack, stroke or some as yet undiagnosed cancer. That is something you want to know. Because if you find out that you have a 10 or 15% chance(no idea, just pulling a # out of the air) of dying from your untreated low volume G6 in the next 25 years, compared to a 30-50% chance of dying from something else, then are you certain taking a chance(and a pretty good chance at that) of some forever SEs that can make your remaining life way less enjoyable is something you really want to do? Any surgeon who makes recommendations to you has quite a conflicting interest he must over come to give you a truly unbiased opinion about
what is best for you, as opposed to best for him. If you have surgery, he will get many thousands of dollars and if you don't he will get zero from you. If you get bad SEs, you get them all and he still gets the same money and no SEs. So get some other opinions just in case he is unable to over come human nature!
Now i know what your thinking, buck!
What if? What if you are not a warm and fuzzy G6 but actually a mean and nasty G9 like me? And it is true that you could well have a G9 hiding in that misbehaving little prostate, it's true. But as far as I know, there is little to no evidence that G6s ever become G9s, and some evidence that they do not, and little evidence that if you have a known G6 you are significantly more likely to also have a G9 than some undiagnosed person out there. Y'all correct me if I'm wrong about
that.
YES, G6s have surgery and then find out that they actually had a higher G score, just as some find out they actually had a lower. But I think it could just as easily be that your Bx can show ZERO PC one time, and a G9 the next time. It is not hard for the needle to miss something, and close does not count. I don't see how we can make life altering decisions about
what MIGHT be in there. If that was the case, since every 45 year old man MIGHT have a G9 PC hiding in them, then why not just cut the prostate out of all 45 year old men just to make sure and be safe? Because any one of them MIGHT have a G8-10 PC, and in fact you can bet your bottom $ some of them do indeed have that. Very few, but some. But why take a chance?
You have to go by what you know, or so it seems to me. And you have actually been given a glorious gift, because based on what you actually know(and not speculation on the unknown possible disaster) you have almost no, or very low, chance of dying from PC, even if you do nothing! Since the SEs of any treatment, and I think especially surgery, can/sometimes suck so bad( a whole bunch of us here can attest to that, even if some others have done great), then if nothing else your great odds should cause you to slow down, take a few months and gather info from some unbiased sources if you can find them and decide if you are better of with RT or surgery or even nothing at least for a while yet. Remember, the least SEs(like zero) is AS, unless your cancer advances which is unlikely if you actually are a G6.
Do not be rushed! If you are going to take a chance on being both incontinent and impotent(or variations on that theme) in your 40s, you at least want to make sure that you had no other choice if you wanted to save your life.
As for surgery not being an option after RT, read over this by the guy who did my surgery(Smith):
www.ncbi.nlm.nih.gov/pmc/articles/PMC4220384/ I wish you good luck and a calm mind in your decision process!