Posted 9/19/2015 3:18 PM (GMT 0)
jronne, I think you are VERY wise to expand the scope of your treatment options to include radiation.
There's a learning curve for those of us looking at it, that's for sure. But the forums are great for getting us up to speed, as is our own independent research.
As far as radiation, there are a couple of things to know, which you may already.
First, you have a world class facility at UCSF. Plus, just down the road at UCLA, Dr. Demanes is one of the pioneers of HDR and Dr. King is one of the pioneers of the cyberknife radiation treatment. Both of those treatment therapies have excellent survival numbers at 9/10 years out now for the low/intermediate risk patients, and both have less risk of permanent side effects than surgery, especially the HDR monotherapy.
Second, not all radiation oncologists offer ALL the radiation therapies. Some do only seeds, some only do cyberknife/SBRT, some only do HDR, and others do a combo of those.
Third, radiation treatment is delivered by a team of which the radiation oncologist (RO) is just one member. You therefore look for a team that has been together for awhile and has extensive experience preforming the radiation therapy you're looking at. The team also typically includes a physicist who helps with the dosing, a therapist who actually hits the button to turn the radiation machine on, etc. Thus, unlike surgery where the skill of the surgeon is paramount, there is no comparable skill with the RO. The machine does the work after it's been programmed.
Fourth, you will want to research (1) which radiation machines are state of the art for the various procedures you are considering (for IMRT, you want an IG machine - "image guided" machine), (2) which of those machines have good track records with the fewest permanent side effects, and (3) whether the radiation oncologist you meet with has those machines.
Fifth, if a cancer recurs after treatment for a guy with your numbers, it generally means the cancer had already spread outside the gland prior to treatment but evaded detection. If cancer recurs locally after treatment, that is, it appears confined to the prostate, HDR is available to treat it, even if HDR was originally used. With surgery, the surgeon has to decide how close to get to the penile nerves and typically some of the prostate is left so as to minimize damage to those nerves. Cancer can therefore either remain in the surviving prostate tissue or develop there, which is why some surgeons recommend radiation after surgery as part of the treatment plan (in which case I think the person is generally better having skipped the surgery and its attendant risks in the first place....)
You may have already seen this thread on the treatment options, but if not, have a look:
https://www.inspire.com/groups/us-too-prostate-cancer/discussion/29-prostate-cancer-treatment-choices/
This is my research on HDR monotherapy which you may qualify for: https://www.inspire.com/groups/us-too-prostate-cancer/discussion/side-effects-hdr-monotherapy-seems-to-have-the-least/?page=last#replies
There is a lot to learn, but it's not exactly rocket science. You are young. The surgical risk of permanent impotence and/or needing the blue pill for the rest of your life is very real, regardless of the surgeon's reputation. Explore all the options for your level of cancer and talk with the various specialists (urologist and radiation oncologist) preferably AFTER you have educated yourself so you know what questions to ask and can have an intelligent discussion about what's best for you.
Yes, that's time consuming, but......