Decisions

As a continuance to my earlier thread about being 1 year since diagnosis, I thought I'd put together some comments on my decision process. For me, and for many of us, there are really two decisions we make, one after the other. The first decision is to treat or not treat. With a low to intermediate diagnosis, there is a starting decision to be made. Do we start down a path toward aggressive treatment, or do we go into an AS program?

For me, and for many others, this is not a simple decision. It may be more challenging than the second decision, which is deciding which direction of treatment to go for. For me, I think the key to choosing aggressive treatment over AS was twofold. One piece was the opinions of the physicians I was consulting with. They all agreed that based on my family history and my relatively rapid PSA increase (doubled annually 3 years in a row) that I was likely one who might be able to do AS for a year or two, but not much longer. I knew at the time that my overall health was good, that my life situation was stable and supportive, and so I felt that if I had the choice between "now" and "not a lot later", that it didn't make a lot of difference. I don't recall having the "get it out of me NOW" mindset, and I don't remember being particularly freaked out by the idea of AS as some report.

The second decision, of which direction of treatment to pursue, was also complicated for me. I had watched my Dad go through PC treatment starting in the early 90's up until he died of spinal metastasis in 2004. From his experience, I knew right up front that I wanted "tried and true" over "experimental". He went experimental as his primary choice, and it may have been a mistake. There were practical considerations at work here as well. The external beam radiation therapies were challenging in a practical sense, as each treatment would require a 4-6 hour round trip drive that I wouldn't feel safe doing on my own. Honestly, brachytherapy creeped me out--the idea of having radiation sources permanently installed in my body had a huge "ewww" factor for me.

All of that set me on the path for surgery. My local Urologist and local community hospital exclusively does open surgery. The local guy was more than willing to refer me to Dr. Figenshau at Barnes-Jewish in St. Louis for robotic surgery, and that is the path I eventually took. I've had a great outcome, and am happy with my choice.

In the end, we each have to look at all the factors that affect us, in our lives as we live them. The factors that were significant for me might not be significant for someone else. Someone has likened the decision process to having a large black box with a number of adjustable dials on the front, and only a few of the dials are for 'hard information' like gleason scores and MpMRI readings. Most of the dials are the personal factors that play into the decision.

I hope someone finds these thoughts helpful today.

Actually, it is possible to stumble through this without making a decision.

But...that's another topic.

I enjoyed reading that Halbert; rational, logical and useful. Thank you!

Although not applicable to me.. I loved reading this narrative.

Instead of siting obscure stats to support your personal opinion, instead of making judgmental statements because of personal regrets and instead of forcing your personal beliefs down our throats..you gave a personal narrative of your journey, why you made the decisions you did and how it worked out for you.

So many options for treatment, and we can't possibly know the right one for you based on seeing a signature. Every decision is unique, and formed based on many factors....

I hope many newly diagnosed patients take the time to read this, as it would be so beneficial for them.

Jordan

Here's my decision process:
when I go into a restaurant for lunch I look for one of the following on the menu in this order:

tuna melt
burrito (chicken)
Hot pastrami sandwich
Bacon burger with crumbled blue cheese.

I order the first one I come to. If none of those items are on the menu, I leave and look for another place to eat.

Hope that helps,
Andrew

I opted for HDR brachytherapy. The thought of surgery really creeped me out, the concept of brachy didn't bother me at all. I did a lot of research, and also had the benefit that brachy (either LDR or HDR) was recommended to me as a treatment option by my Doctor, along with referrals to top practitioners. Right when I got the results from my biopsy, my initial reaction was to go for surgery. After consulting with my doctor and cooling my heels for a couple of weeks, I changed my mind.

No hard and fast rules.

No concurrence between specialties about treatment.

Random hypothetical percentages of this and that.

Everywhere I turned for research/info fueled my skepticism of the whole situation I had been dealt.

After realizing I was on my own here with something that could easily kill me or seriously degrade my quality of life,

I went back through the replies I had received and looked at them as objectively as I could.

I found that I would have to make a choice that did not come with all the proof I wanted.

I realized I was ok with leaving my prostate in that had one lobe pretty much covered with G 5-4 cancer.

I learned my treatment survival odds were almost identical although the side effects would not be. Surgery would be much easier than the choice I made and If my doctor would have let me I would have brachy as well as rt and 2 years of ht. I would have a high chance (odds again) of a reoccurrence with surgery alone.

One of the hardest decisions I have had to make because I could not change my mind later.

It's ok though, I completed rt #29 of 45 today and se's are hot flashes, memory loss, and worst of all, fatigue that is turning into exhaustion.

I choose not to be consumed by this or to spend more time than necessary dealing with it.

My choice is just that, my choice and one we all have to make using our best judgment. And really this is just an outline of how I came to my choice. You'all can easily fill in the gaps who have had to choose.

Regards, Bill