Welcome Kat.

You are right to look for statistics to show you which is the better
choice, but I really don't think you will find them.  The results are
about the same.

Say more about why you are scared to death of surgery.

jimhoney
standard (big incision) RRP age 52, cured, no significant aftereffects

(snip)
"Perineural invasion" means that the tumor has invaded a nerve pathway,
which raises the risk of penetration of the prosate capsule.

It is well that Kat has a copy of the biopsy path report. Copies of all
test results and other such documents should be obtained and kept in a file.

First: Because the future course depends upon its accuracy, the Gleason
score *must* be verified by an expert. There is a number of labs that do
this special "second opinion" work, and the doctor should know of them.
He will not bring it up unless Kat and her husband take the lead. The
expense is undoubtedly covered by insurance or Medicare, but in any case
is only ~$340.

Second: Go to the website of the Prostate Cancer Research Institute at
http://prostate-cancer.org/index.html
for information vital to the newly-diagnosed.

Third: Go to the website of the support group Us Too! International at
http://ustoo.com/
for help in research, and in locating a support group in the area.

Fourth: Buy and study _A Primer on Prostate Cancer_, subtitled "The
Empowered Patient's Guide," by Stephen B. Strum, MD, a medical
oncologist who specializes in treatment of prostate cancer, and Donna
Pogliano. I consider it to be fair and balanced regarding the various
treatments.

Fifth: Do not be stampeded into a particular treatment regimen. Study,
learn, take charge! Then and only then make an *informed* choice.

The lives of Kat and her husband (name?) will never be the same, but
that does not necessarily mean that they will be worse.

All the best. Please do keep us informed.

Regards,

Steve J
__
"Never give in--never, never, never, never, in nothing great or small,
large or petty, never give in except to convictions of honour and good
sense. Never yield to force; never yield to the apparently overwhelming
might of the enemy.''
--Sir Winston L. S. Churchill

You absolutely, positively MUST read a few PC books. Your peace of mind,
maybe even your husband's life or lifespan, depend on it. This business and
its decisions are as complicated as many Master's Degrees, and infinitely
more burdened with personal criteria and choices, so get started today. Go
to a bookstore and pick up copies of at least Walsh's '"Guide to Surviving
prostate Cancer" and Lange's "Prostate Cancer for Dummies". Then set aside
the next week or two for studying at least the first 2/3 of each book. Add
Bubley's "What Your Doctor May Not Tell You About Prostate Cancer". Heck,
while you're at it, clean out the PC section of your bookstore; each PC book
adds yet another piece to the most important puzzle you'll ever assemble.

And believe this: any quick answer available here or anywhere else is worth
what you pay for it. EVEN IF IT TURNS OUT TO BE CORRECT, you won't, or
shouldn't, believe and act on it until you've done your own research. Only
by doing that can you emotionally accept and live with the outcomes of the
decisions you two must make. Every book, every doctor, and every one of us
here has biases; it is vital to your mental health, maybe even to your
husband's prognosis, that you learn enough to form your own bias, based on
tons of facts plus your own criteria. Only then you will be able to make a
decision valid FOR YOU GUYS that won't keep you awake for the next several
years.

P.S. Surgery's no big deal. Whatever the cancer has struck must go, so
whether it's removed by a knife, by radiation, by leeches, or by a smart
cherry bomb is just details. I have my biases, based on research and my own
decision papers that flat awed my university and VA team of oncologists (the
gang who collectively wrote "PC for Dummies"), but it's of limited value to
you because you may have different personal criteria and your husband DOES
have different cancer numbers.

Your next month is cut out for both of you. Start reading, spend a lot of
time here asking questions, research all of the websites this group steers
you towards (e.g., Phoenix5, PCRI, etc.), consult specialists in radiation,
surgery, and medical oncology, and get educated. THEN make a decision.

I.P.

I was 58 and my PSA was 10 and Gleason 3+4 (Pathology Gleason 4+3).

My worst times in this process, after the diagnosis, was the stage you
folks now fing yourself in. Read as much as you can.  People here
recommend Dr. Walsh's book and the Pheonix web site and of course this
support group.

I had the same choices as you have been give.  I chose RRP (big scar)
for several reasons. 1) I wanted the Cancer out of my body. 2) Surgery
is not a good option after seeding or radiation (has been desvribed as
"like trying to remove a tennis ball froom concrete"). 3) Seeding in my
case would have required a course of Hormone treatment to shrink my BHP
enlarged prostate.  4) Side affects seemed to be similar in both
modalities.

With hind site I am very glad I chose the RRP.  I am currently 26 weeks
post surgery and except for Erectile dysfunction, all else is back to
normal.  I was back on my motorcycle 4 weeks after surgery and sugical
discomfort after leaving the hospital was managed by 1 night of ty;enol
useage.

Surgery is not a bed of roses and can be a frightining thing to think
about  but with support and knowledge it becomes less so.

Goog luck makeing your choice, We are here for you

Your hsuband's diagnosis is very similar to mine at age 67 about 4 1/2
years ago.  I chose surgery, and I'm doing pretty well.  My PSAs have
all come back undetectable and  I am not incontinent.  I was impotent
for 18 months but now I can manage if necessary without any aids, but I
do better with some Viagra.  During the time I was impotent, my wife and
I had a fairly normal sex life by using a pump.

If your hsuband has a good surgeon, at his age, his chances of not being
impotent would be quite a lot better than mine were.

But of course, I am only one example.

Each method has its advantages and disadvantages, but you should first
confront your hangups about surgery.  The likelihood of not surviving
this kind of surgery for a man in good health is extremely low provided
you have a competent surgeon.  There is no reason to be "scared to
death" of it.  Try to understand what advantages or disadvantages each
method might have.  Since any method which works to cure prostate cancer
has to pretty much destroy the prostate, side effects tend to be
similar, although there are some differences.   Find out about the
likely side effects of each treatment; don't obsess about things that
are actually rather unlikely.

When I was going through the same process about 9 months ago, I was
told that the doctor's experience and track record are more important
than the treatment modality--given that most studies are showing
approximately equivalent results for radiation and surgery (for PCa
victims with stats similar to your husband's).  At the time of
diagnosis, my PSA was 4.5, Gleason score 3+4, age 62.  I ultimately
decided to go with a seed implant at the Massey Cancer Center in
Richmond, Virginia, because of the doctor, Michael Hagan's, track
record and knowledge of this disease.  I was leaning toward radiation
because, like your husband, I was fearful of surgery.  However, had I
found a surgeon nearby with a track record similar to Dr. Hagan's, I
might well have taken that route.  As others have said here, do your
homework.

Ron Carter

Good Morning Kat,

I understand how hard this is on you.   It's probably harder on you
than your husband.

I was diagnosed last year at 57, PSA 10+, Gleason 7=4+3.  

First the good news, the uro-doc told me that I'd probably live
10-12 years without any treatment.  He also said that with my
staging, general health, age, and Gleason score, that all the
treatments were open to me.  

It was my choice.  

He discussed surgery, spoke for it, and said that I would have no
problems with it.

He sent me to the Rad-oncologist team at Northern Virginia's Inova
Cancer Center.  (top notch group, my opinion.)

They did an MRI, a bone scan, CAT-scan, and an ultrasonic volume
study.  If you have these tests before you make your final decision,
each test adds more insight.

- Outcome at 10 years -

Both the uro and the rad-onco docs said that the outcome would
probably be the same but that the rad-studies only went back 10
years.

Either way you're looking at a better than 90% chance of being
cancer free at 10 years.  Where cancer free is defined as still
alive with a low, not-rising PSA and no symptoms.  

- Side Effects -

There is no guarentee either-way, Surgery or Rad.  Both can go
wrong.  

The surgical side effects are what they are.  When you're cut open
it will take time to heal.   There is pain but the biggest complaint
seems to be incontenance.    I have an associate who went the
surgical route at Johns Hopkins, he's still incontenant and using
pads 2 years later.

Rad is almost side-effect free in comparison.  A very small
percentage of Rad patients experience nasty side effects, bowel
problems, urinary stoppage.  The percentage is small but it is a
risk.  I can't speak to these as I did not experience any of them.

For Rad, there are a suite of side effects that everyone has but are
so insignificant that the books gloss over them.  

I used to sleep 6-7 hours a night; after rad, I was sleeping 9-10
and feeling tired.

I never got up at night to pee.  After rad, I get up 2 and 3 times.
The longest I've slept is 5 hours.  It's getting better but the
books say this can go on for 6 months or longer.

- Life -

Rad did not interfere with my life.  I had 25 IMRT treatments. They
gave me the 7:00 AM slot, Inova's Linear Accelerator #2 is on my way
to work so I was at my desk before 8:00.  

The Palladium-103 seeding was at 8:00 AM.  At 10:30, I was
walking out of the outpatient building under my own power.   That
afternoon, I did have some blood in my urine but it stopped by 3:00
PM and the next day, I felt fine.  

I could have gone to work but I took the next 4 days off, just
because.

- Cost -

Over the last year, I took a fair amount of sick leave. Mostly
half days to go for tests and consults with the docs.  That's what
it's for.   I expect that I'll take a handful of days this year.  

The bill was over $50,000, all covered by insurance except for
$3,000 of co-pays, prescriptions, etc.

I'm approaching 4 months post-seeding and feel pretty good.  

Kathy,

The stats are about the same for either treatment.  At his age and stage of
cancer, he has all treatments at his disposal.

Personally, I like the surgery.  You need not be afraid of surgery.  You
won't believe how easy it is once it's passed.

Both RT and surgery have benefits over the other, but most are not that
major.  The one benefit wives like with surgery is the possibility for nerve
sparing which would highten his chance of having sex again down the line.
However, with perineural invasion, the doc may get in there and find he
cannot save the nerves regardless.

You and your husband need to research, research, research and come to a
decision.  Once done, don't look back.