Go with local prostectomy surgeon or pursue big center 2.5 hours away

@heavyphil "But I would rather be Erect than ‘erect’ any day of the week!" lol yep

@fritzo I'm not familiar with those studies. A friend of mine went with Proton and hasn't had near the side effects I had with EBRT. Definitely not a scientific study. Cure is at the top of my list. I think surgeons oversell nerve sparing. They don't get paid if you go with radiation.

@chippydoo
Yeah, it's like selling cars. You sell what's on your lot, not what's in the next lot.

Proton seems like it would be great, but it would be challenging to travel every day for nine weeks of treatments. But, better side effects would provide motivation.

@fritzo We only have one proton center in central Virginia. My buddy drove and hour and a half each way for 50 days of treatment. If it would have prevented the radiation proctitis I am experiencing a year after radiation I would view it as a bargain.

22 years ago at age 54 I was diagnosed with 4+3. I was in a dilemma as local urologist wanted to do surgery. My GP advised " go where they do this day in, day out". I did. I had robotic surgery by a doctor who has done probably thousands, followed by radiation. Despite a concern about possible spread to bone, I didn't have a return of PSA for 6 years. For the last 16 years periodic shots of Lupron. I do have side effects but still I am alive!
I was able to raise my family.
Thank the good Lord and a doctor's skill.

@chippydoo
Yeah, so hard. I'm not 100 percent thinking surgery based on my Decipher test result of .61. that just came in yesterday. But, if I have recurrence, than proton sounds like it should be my salvage treatment of choice (suspect it would be combined with hormone therapy based on my Decipher test result). Thanks for the good advice and so sorry you're going through the proctitis.

@airportone Such a blessing! My wife was diagnosed with a serious lung disease (pulmonary hypertension, which is very rare) and the docs told her to make her arrangements. Our kids were very young. We went to a top specialist three hours away for the same reasons. (It is now 26 years later and she's still being a mom, now to her adult children. and two grandkids. These are the things that matter most. So happy for you!

@tootall10 True…but would you want to be his FIRST??

Mark Scholz of PCRI has a video up where he discusses radiation vrs surgery.
search on: "A Medical Oncologist Compares Surgery and Radiation for Prostate Cancer | Mark Scholz, MD | PCRI" He favors radiation, saying he hardly ever prescribes surgery any more.

Dr. Geo posted part of his interview with Michael Zelefsky on this topic. Search on: "Surgery vs. Radiation: What’s the Truth? with Dr Michael Zelefsky | Dr. Geo Insights".

Zelefsky has been a top flight very influential researcher and clinician for decades. He sums up his discussion saying all the treatments are so much better than only a few years ago that if you find someone and a treatment you believe in, do it. You won't be that far wrong, if you are. I noticed that Zelefsky is based in NYC, where, he says, the surgeons are outstanding, and the radiation treatments are state of the art.

He himself is using an MRI-Linac, said by some to be the latest and greatest external beam that exists, combining it with HDR brachytherapy when he's treating high risk patients.