When it rains, it pours.  Sorry for your deluge of troubles.

How did the doctor know to look for PCa with a PSA of only 3.6?

Strongly recommend a second opinion on the diagnosis.  Not a second
biopsy, just a second reading of the slides.

That 50% chance of avoiding impotence is wrong wrong wrong.  Unless
that's the best that doctor can do.  You've almost certainly got an
organ-confined case, and a qualified surgeon should be able to identify
and spare both nerve bundles.  Your chances of impotence should be less
than 10%.

Don't rush your decision on treatment.  See another urologist.

jimhoney

Some things to remember.

1)  All methods of treating prostate cancer may lead to impotence.  With
surgery, there is usually immediate impotence, but in a large number of
cases, erections return in 3 months to a year.  Sometimes, particularly
in older men, it can take up to 2 years or more.   After radiation,
impotence can develop up to 2 years after treatment.

2)  If you choose surgery, the skill and experience of the surgeon is
crucial.   Skilled surgeons have very high success rates for avoiding
impotence in young men like you, 80 percent or higher.  If your surgeon
can't do better than 50 percent, you should consider finding another
surgeon.  Travelling to another city for treatment might be worth it.

3)  Impotence can be treated by a variety of mechanisms.  It doesn't
have to lead to an end to your sex life.   I was impotent for 18 months
following surgery, but my wife an I managed reasonably well, having sex
without about the same frequency as before my surgery.   I used a VED or
pump.   There are also other methods.   (I was 67 at surgery, so my
chances of avoiding impotence were much lower than yours should be.)

There is a new book on the subject by Glen Bubley entitled something
like "What Your Doctor May Not Have Told You about Prostate Cancer".  It
is written by an oncologist who does neither surgery nore radiation
treatment for early prostate cancer, so perhapsy he can give unbiased
advice.  A standard reference is Patrick Walsh's Guide to Surviving
Prostate Cancer.

Your cancer is such that it ought to be possible to cure you without, at
your age, major side effects.  Educate yourself and find the best
doctors you can to provide treatment.

Good luck.

You don't know it now Kevin, but you are in good shape.  Stick around here
long enough and you will know what real trouble is, e.g., there are guys
here in their early 40's with metastases, guys who cannot work because of
conditions like osteoarthritis, and the list goes on.

One thing you need to do is gear up for some serious decision making on the
PCa treatment.  I would highly recommend that the impotence be a secondary
consideration as you evaluate your alternatives.  I know at your age that
does not sound reasonable.  I've heard guys say that they would rather die
of cancer rather than be impotent.  That attitude is what is not reasonable.
For one, as others will no doubt tell you, your chances of long term
impotence with nerve sparing surgery, by a experienced competent surgeon, is
a lot less than 50% (note the emphasis on nerve sparing surgery and
experienced surgeon).  Second, there are a lot of alternatives to treat the
impotence.  Some guys here have bragged about their implants, no premature
ejaculation problems there, and how they keep all the widows in the
neighborhood happy (I know a couple I would like to make happy, but my wife
would never hold still for it).

Read, study, keep a positive attitude.  Seek out the best medical advice you
can get and once you have made the treatment decision do not look back.
And, by the way, you have found a great place to discuss your PCa problems.
A great bunch of people here.  Personal experience in all the treatment
options, and I have not seen anyone try to "sell" one approach over the
other.  Just the facts ma'am.

Good luck to you.  BTW, pay attention to the comments from the wives.  I
don't think you will find any telling their husbands to avoid a treatment
because of the possibility of impotence.  As you enter a new relationship I
would try to find one like that.

Thank you.
David S.

Hello Kevin,
   I would favor surgery only because I had it done in 1999 and I was
49........I have regained all normal physical aspects that a man could want
and have also rid myself of prostate cancer so far.
Explain to your kids what is going on and a little education on the matter
will clear up their uncertainty.
Walking prior to surgery and after surgery is beneficial.
Good wishes, and good luck.
John Loomis

good day,

Here's the good news.  At your age, staging, Gleason, all the docs
are itching to treat you because you will probably add to their
positive statistics.

Look at all your treatment options, take your time, think things
through.

Hi, Kevin...

At your age, most all the literature is going to lean toward surgery, as it
is the *gold standard* for eradicating the prostate cancer.  But there are
differences even with surgery.  Read up on Retropubic Radical Prostatectomy
(the old standard), Laparoscopic Radical Prostatectomy (using laparoscopic
techniques to perform the surgery), and Robotic (or DaVinci) Radical
Prostatectomy, where the doctor actually manipulates robotic equipment to
perform the surgery.  I had LRP a little over two years ago.  I'm 54 years
old.  Continent.... and impotent.
At 43, your chances of regaining erections is much greater than for us older
guys.

In case you have not found it, look at www.phoenix5.org for lots of good
info.

Best of luck to you.  Keep us posted!

MikeH

Best of luck with your decision Kevin. I see you have joined the 1%
Club.....As, I when the day after my biospy landed me in the hospital for
four days to deal with the infection.

I opted at age 56 for seeds and external radiation on the Peacock. I am
different in that my PSA never dropped after that...period....... A year
later I had a PSA of 32.3. Both Radiation Oncologists and Medical Oncologist
(who specializes in Prostrate Cancer) agree that no matter which primary
treatment I had, it was too late.......

After six months of Phase II Chemo and Hormone treatment in a Medical School
research trial; PSA is 0.5 for two months in a row and scans have returned
to a "clean" status.

My best advice is that Prostate Cancer is no party, you are a statistic of
1, and your decision is the best decision.

BTW, I still have solid erections, even with a testosterone score of 3.0.

Mike

Kev,

Re PCa, you really have no choice at 43 but to have surgery.

Re the rest of it, I'd give very serious consideration, knowing absolutely
nothing about it, to reinstating your marriage and/or your job if either are
possible.  PCa is almost an automatic depression-maker.  Losing your
marriage is one of the highest stressors imaginable.  Losing a job for a man
is one of the highest stressors imaginable.  You are seriously in danger of
overloading.

Dear Kevin,

Things come in threes so console yourself and also visit  www.rcog.com as a
possible solution. They have a very full website and I found them excellent
myself. You have a good chance of non-side effects recovery with your
presentation and Atlanta is a fine place to spend three months. Its a long
way from Sydney but well worth it all and borrow the money. I was in
Rockhampton, Queensland when I was first-indication diagnosed. Lots of good
women out there too and the change will be good for you in every way. have a
XXXX and ring RCOG. Just to get a position on this generally. Avoid radical
prostatectomy anyway is my suggestion!

Minerva