Thought I'd throw in my two decrepit bits

Your decision.

I'll tell you how mine went...

First I set priorities:
1) Quality of Life
2) Length of Life
3) Non QOL or LOL affecting SE's
4) Losses of Functionality or Options due to Treatment

(#4 turned out to be a big one!!)

Then, research, research, research...

1) Found most statistics to be useless. Controls not convergent (too
many changes in diagnostics, treatments, demographics over the
statistical time frame), Not enough time/data (standard deviation
pukes!).

2) From information available and my situation (yours will, of course,
be different) the major treatment options. EBRT, seeds, RP, LRP,RLRP)
showed no confirmable (screw the statistics) difference in rate of
success for treating the PCa. I was not particularly concerned about
the standard SE's (sexual or continence). Just wanted to get rid of the
cancer (see priorities).

This left me with lower priority items to evaluate and that evaluation
was how the proverbial sh.t-hit-the-fan for me.

1) Recurrence treatment: If surgery (ANY form) doesn't work, salvage
radiation is possible. If radiation doesn't work, surgery is generally
not an option. At this point there are only two "curative" treatments
for PCa: surgery and radiation. Seemed to me that I ought to maximuize
my "curative" options so surgery went to the top of my list. Someone
posted here that there is NO cure for Pca. They are statistically
right, and that can be said for almost any (probably all) cancers. So,
if you "screw the statistics" you're left with this as a qualitative
decision. Options are still options, as many as you can gather around
you.

2) OK - which surgery? This one was tricky. Most surgeons will not
argue about the benefit of being able to feel as well as see. LRP and
RLRP eliminate the ability to make tactile analysis and decisions.
Having said that, what are the downsides of RP? Recovery, infection,
blood loss - all temporary. Any permanent? Yep!! (I'm not completely
competent in explaining the following phenomenon so feel free to jump
in) A vertical incision the size of RP - from the belly-button to the
you-know-what - severs many small and medium size blood vessels, both
arterial and veinous. Al these vessels don't generally "grow back", but
some must if the tissue they nourish is to survive. Some of the load is
taken by "going around" but much is though less-than-perfect bridging
of the incision during healing. Think of it like the difference between
normal and scar tissues. Anyway the idiom might be stated as "not a
good idea to cut twice in the same place". Twice may be viable, three
times, from what I understand is a definite no-no. That has certain
implications if you need to undergo successive surgeries in the same
organ area - like the colon or the stomach. I was lucky (and unlucky)
to be provided with an example with my mother-in-law. She had severe
gastro-intetinal problems all her life (her own fault). She had her
stomach REMOVED, part of her Colon removed and one other (can't
remember what for) - all in the same general area. Her third incision
(same area) never really healed. Her final downfall  necessiated
surgery to correct a blood flow problem - in the same area. They
couldn't do it! There was no way they could make any kind of an
incision and not induce overwhelming tissue death (they got a better
name for that but I can't think of it now). Anyway, she died. When you
think of it, it makes simple sense - cutting into ones flesh never has
an overall  positive impact - there is always trauma - some is always
permanent (scar tissue at the least). The less cutting that has to be
done, the less trauma is sustained. Makes common sense to me.

There was a final decision. Who and where. Everyone wants the best
surgery/surgeon possible, however IMHO the length of a surgeon's
credentials is asymtotic to the benefit derived. My local oncologist
had executed  100's of successful LRP's and `1000's of successful RP's.
His bedside manner was less than optimum. He was direct and concise - I
had to remember to ask lots of questions - he didn't offer much outside
the "necesssities" unless pressed, but then he was always forthcoming
and accurate. He could perform the surgery locally and that meant my
familiy and friends could be around me. Back to attiude and support is
everything. The facility was top notch and state-of-the-art surgically
(not so great post care/recovery, but ya can't have everything). I
chose that option. I could have gone to Sloan, or Roswell, or a dozen
other highly recognized facilities - my insurance would cover it, but I
would be alone (except fo rmy wife - of course). What was available
locally was significantly better than "just good enough". I chose to
opt for my support network. I'd do it again - it meant everything.

A quick story before I leave you (I hear you say, "Thank God!!").

At my six month follow-up my uro gave me a memo that stated that he was
leaving the area for a new teaching position. At the end of the
appointment (we had become relatively good friends) I asked him why.

He smiled, "I can't get this hospital to invest in a robot!"

My retort, "You have always said that LRP was as good if not better
than RLRP!!"

His reply, "It is, in my hands. A computer can't make changes to adjust
for the unexpected."

"So why?" I repeated.

"Because that's what the patients want, no matter what I tell them." he
replied,  "There are lots of  less experienced and less capable
surgeons our there, and the robot doesn't make mistakes if  everything
is as expected. In my opinion robotic surgery provides me with less
information and ability to analyze the situation than LRP does, and of
course much less than what RP does, but you got to be good for those,
really good. I think I am..."

"So the paitent rules?" I quipped, smiling.

"Yep!"

He's now at Mass General...

See Ya!!