New Guy

Welcome to our corner of the world. Selecting a treatment is a tough one. With your numbers either surgery or radiation would likely work just fine. The choice between the two isn't that clear cut and you'll be hard pressed to find any good numbers.

I chose the external beam radiation and so far I am very happy with my choice. It avoided some of the trauma of surgery but isn't without it's problems. The treatments are daily for 6-8 weeks (you get weekends off) and can be a bit of a endurance test to get through. I had a bad case of fatigue (others didn't get that) and my hemorrhoids acted up.

In my case I opted for radiation because I am not the best candidate for surgery - heart and lung issues so that pushed my case over to the radiation side.

Wish there was something that would show a clear cut -do this or that - but both work and both have their draw backs. I'd say that if you leaning towards radiation you'd be just fine doing that as your primary treatment.

Could that fail or go wrong? yes but so could surgery.
Sorry that's not a helpful as you'd like.
All the best,
Andrew

Your post indicates you have confirmed PNI. That is something to be considered when selecting a treatment. My understanding of PNI is that it is not a definitive sign that PCa has escaped the prostate but gives PCa cells an easy route out. My numbers are similar to yours with confirmed PNI, I have chosen IMRT and brachytherapy. The research i did indicated that the combonation therapy would be the best for me. I am currently in treatment. Take your time, read the books, do the research and be confident in the treatment you choose for yourself.

Hey been there and did that( over 10 years ago now) and to the max. doseage of external and got one of the most unique protocols available (now very rare because you need a Cyclotron for the neutron ray machine). Back in 2002 I got a dual radiation protocol like this: 10 sessions Neutron rays (Cyclotron used-this is the most potent radiation ray their is, Proton is next and then Photon), thenafter got 24 sessions or so of Photon rays via IMRT machine. In my case it went well and side effects were mild and no nasty long term issues, fatigue during or right after radiations lasts awhile and then subsides. Alot depends on the experience of the people doing such and the type of delivery and equipment, don't use a newbie radiologist. There are many choices on radiations and combos of IMRT and Brachy seeds.

Info sites: www.rcog.com       www.dattoli.com     (they have cd's or info packets you can get)

Photoman, I too will say welcome to the club no one really wants to join - but you are in good company. When I got my Dx of PCa in early July of this year and went on my learning mission, this site was / is a huge part of my decision making process. Here you will find a plethora of experienced guys that as I like to say have "been there, done that" with respect to the journey you now find yourself on.

In addition to getting input from those that have experienced this battle against the beast you should also immerse yourself into learning as much as you can about PCa and all of the treatment options available. Also get multiple opinions from those in the various realms of the medical profession with respect to what is available for treatment. Be aware that as you talk to those in the medical field most surgeons will recommend surgery, most radiologist radiation and so on. When you talk to them find out what their level of treatment experience is - i.e. how many have they done in their career, how many in the past year, and so on. Also insist on getting their specific statistics on things like % chance of recurrence after treatment, continency and ED issues - and have them explain for instance what "continent" means - for you and I it would be NO issues, for some it's "only 1-2 pads per day."

For me personally I decided on LDR Brachytherapy - had it done on September 21st of this year. Virtually no side effects and am waiting for my 3-month PSA read on December 20th to find out how those little radioactive seeds did.

As I have offered to other "newbies" - during my research I downloaded and/or purchased a number of studies, reports and articles that I would be happy to share with you. One of the most current, and intenstive report on results of the different treatment options is the "Grimm, et al" report that came out earlier this year. This study was the first large scale comprehensive review of the literature comparing risk stratified patients by treatment option and with long-term follow-up. If you are interested in getting a copy of this and other related doc's, shoot an e-mail my way and I'll reply.

Best of luck to you - ask all the questions you want out here, you'll find a great group of folks more than willing to share their experience.

Hi Photoman, welcome to HW but sorry you have to be here.

Unlike another poster, I would absolutely not recommend surgery for the stats you presented.  The fact is that radiation and surgery provide similar curative outcomes but radiation generally provides less onerous side effects.  I think you would be a great candidate for brachytherapy + IMRT and the results from that are generally excellent.

Don't be fooled by the notion that you should have surgery and "save" radiation for a possible salvage treatment.  That argument, in my opinon has been debunked on this site many times.  A common sense approach would say that if you need the radiation after surgery to get the job completed then the radiation probably would have done the job right the first time.  Additionally, there are options for failed radiation that are just as effective as option for failed surgery...just different ones.

Anyway, that's my take and I wish you luck.  Please keep us up to date and PLEASE choose a doctor who is highly experienced no matter what final treament choice you make.

Jim