@climateguy hello... you've gone through much of what I'm going through now. I've had all the tests..starting with psa... ultrasounds... biopsies..my doctor told me I've got stage 2b prostate cancer. In his opinion surgery was my best choice. However I've been researching all of the treatment options... including proton .. photon..brachy seeds....but now I'm going for 2nd opinion at Vanderbilt hospital...my biggest concern about radiation is the possibility of damage to other tissue and organs. My biggest concern about surgery is the pain,the catheter...so as I said, I'm going to see another urologist soon to weigh the options.. i just don't know... I've also heard that if I choose radiation first and it doesn't work or cancer comes back that the risks for surgery becomes a lot higher. But if surgery fails I would still have options for radiation therapy.... I'm just going crazy stressing about this. I had 12 biopsies .... Gleason scores of 6and 7s... Grade group 1 and 2s...so anyways...thanks for your input....

@climateguy
It is hard when told you have PC to know what to do. You also can get overwhelmed with information from others and then like you posted conflicting information from medical professionals.

I don't think I saw you were given information on proton radiation. They have pencil beam and scatter beam treatments that have the same success rates of photon radiation. The difference is possible reduction of secondary damaged, and secondary cancers caused to surrounding organs and tissues that photon can have a higher chance than proton.

The biggest difference in the types of radiation is not success rates but photon radiation continues throughout body where proton stops at specific spot.

I still ponder if I made right decision on dosage. I had consultations with Mayo urologist, Mayo R/O, UFHTPI R/O, and my Mayo PCP. I went through the complete prostate cancer information package given to me by UFHPTI prior to considering coming to them for second opinion.

I sometimes ponder whether should have gotten the 5 days high dose versus the 30 low dose I got just to get it over quicker. Put then my Mayo PCP and UFHPTI told me after the 5 high dose treatments started they were seeing more side affects sooner.

I hated to be told I had PC and it did change my life. But I feel I did everything I could to find out all treatment plans and the pros and cons of each. I don't think I could have done more so I have accepted did the right for me personally.

I did not see from your post that you had a Decipher test. Did you have that test.

@climateguy Your story certainly stirred up some painful memories for me.

I also had in depth consultations re: radical prostatectomy and radiation treatment. My docs were very upfront about the pros/cons of each. What made me decide on the surgery was the aggressive state of my cancer. I carry the BRCA2 gene — and tim was of the essence. But a biochemical recurrence doused my good fortune after just 13 months. PSA left the “Undetectable” world and I had to do the radiation hormone therapy. Now, nearly two years after my last radiation treatment, I feel great and turning in those 0.01 PSA labs.

I wish I could offer a definitive answer on which way to go. But I think it just depends on your own situation.

@climateguy
"Yes indeed." Bottom line: There is NO PERMANENT CURE for prostate cancer. I KNOW that my urologist said that I should have the prostatectomy because "it is 100% curative." When I challenged him on that he said: "I never said that." I said: "you most certainly did say that...why would I say that you did...where would I have come up with that?" He repeated: "I never said that." He was already covering his butt, because my surgical pathology report came back with, among other things, "surgical margins" to which he had to admit that he "didn't get all of the cancer" out of me, because I had EPE. Despite left seminal vesicle invasion, and the fact that he removed the entire prostate, both seminal vesicles, and both vas deferens, my pT3b classification because of the left seminal vesicle invasion means that a LOT of men just see their cancer return "within" five years post-op. The more that I read, and the more that I read here, the more I am convinced that there is no permanent cure for prostate cancer despite prostatectomy and radiation, and even the dread ADT hormonal therapy. Each is just "the next" treatment modality to hopefully give you several years to maybe a decade or more of life, BEFORE it comes back. It always seems to come back. Granted...this Mayo blog is a subset of men with problems with their cancer. The men who have successful prostatectomies with no later issues, never write here...they don't need to. They were "100% permanently cured" I guess. But I do not know those statistics...how many men have prostatectomies and never have any later recurrence requiring anything more in treatment like radiation or ADT hormonal treatment? I'd sure like to know that statistic. Dr. Walsh even states in his book, that traditional outcomes are the same whether you have immediate "Adjuvant" radiation therapy, or you have "Salvage" radiation therapy 6 months or later post-op. We read of countless men here who had the prostatectomy, and they were good for years or a decade or more, then...it came back. Then they had radiation, and they were good for a couple years or more. Then...it came back. I want to know why the hell it comes back? How can a man with a full radical prostatectomy with both seminal vesicles and both vas deferens removed with or without EPE see that cancer come back after the fact? How can that same man who then undergoes a course of radiation therapy, be good for so long, then it comes back. This is why physicians say that they "practice" medicine, because it is imperfect...nothing is ever a complete cure. They just do surgery and treat to delay the inevitable. The only good news is that it is mostly a slow growing cancer, that gives us the humorous luxury of saying that "most men with prostate cancer will die of something else." That is hardly humor. I have had a very "A+B always equals C" life. I was a clinical laboratory director. I ran and controlled the production of the very labs that run and report the PSA tests and every other test that can be done on the human body. You would not believe what labs do to validate the accuracy and precision of lab test methods on instruments, and what is done if the exceedingly tight limits of quality control and calibrations are exceeded. Yet, we can get this prostate cancer, and turn our bodies over to surgeon urologists...basically "human body mechanics" to remove the cancer...but they fail every time. They leave some cancerous tissue behind, that comes back to face other treatments with horrible outcomes while "hoping" to kill "all" of the cancer once and for all. But...ooopps...it doesn't...so we go to the next step of treatment and hopeful cure that never happens. I should have gone the route that my dad did: he lived to 99 years and 10 months "WITH" prostate cancer. He never had the prostatectomy or radiation or anything. He suffered greatly his last five years with monthly urinary tract infections due to his massive enlarged prostate. They were often fungal in nature so he had to be admitted to the hospital for I.V. administered anti-fungal meds (there are no pills for that). But he never suffered the surgery, the recovery, the follow-up radiation, the follow-up ADT hormonal treatment, etc. Can you tell I am angry about my post-prostatectomy cancer? It isn't over: my physician knowingly left cancerous tissue in my body that WILL GROW, unless I am exceedingly lucky and the cells die due to their blood supply being removed. So now I am talking to a radiation oncologist who will put me in a diaper for the rest of my life (20 years more I hope), and kill my sex life making me permanently impotent with erectile dysfunction. What kind of "quality of life" is that?