I didn't want to hear that Curtis.  I wanted someone to tell me,
"Nah, you don't need that, it's just a pain in the a.s and doesn't
do any good."

But then I'd also like someone to tell me, "Alan, you really don't
have cancer.  It was all a mistake.  You don't need any treatment
at all."

Pulling my head out of the sand, and recognizing that what I don't
know sure as hell will kill me, I see that your advice is probably
sound, and I thank you for it.

I've been studying everything I can find on PubMed, Cancer.gov,
Phoenix5, and other sites and will try to make a decision as soon
as I can.  Unfortunately, the evidence is not just unclear, it's
sometimes downright contradictory.

Regards,

  Alan

Heather,

You didn't miss my decision.  I made it the day I posted the question
on hormones.  You saw it first right here.

One of the propositions that every single article I've read seems to
agree on is that the long term outcomes for radiation are as good as
for surgery.  I think that, psychologically, that's hard to accept.  My own
cousin, an oncologist specializing in breast cancer, told me that the
long term outcomes are the same, but if he had a tumor he'd want
surgery just because, psychologically, he'd want to be rid of it.

For me, the psychological factors are not as strong.  I had a knee
surgery once that was a disaster and made me very leery of allowing
someone to cut me open in order to heal me.  So it was easier for
me to see past the urge to cut the damned thing out and take the
proposition of equal outcomes seriously.

I also see clear evidence that, the higher the radiation dose, the
better the long term outcome.  So I'm hoping that the relatively new
HDR therapy may have an even better long term outcome than
more standard RT - which is already very good.  My understanding
is that the early evidence for HDR is that it's as good as any other
radiation therapy.  Whether it's better or not is apparently not yet
established.

The hormone question is (hopefully) the last real bear for me.  The
more I research it the more disturbed I get.  It seems to have clear
benefit for patients with Gleason >= 8, and no demonstrated
benefit for patients with Gleason <= 6.  I'm a 7, and the evidence
is not well established either way.  It might be just the thing to tip
the balance and save my life, or it might be an unnecessary
treatment that hurts the quality of my life now, and over the long term
future.

Whatever choice I make, I'll never be able to tell if it was the right
one.  If I get the hormones and don't die, I won't know if the hormones
contributed to my recovery.  If I don't get them and the disease
comes back, I won't know if hormones would have prevented it.

So, as the man says, you pays your money and takes your choice.

The actual HDR and EBRT will be done at the National Cancer
Institute.  I work there as a computer programmer and naturally turned
to them when I was diagnosed.  I'm entering a clinical trial that tests
MRI guiding HDR catheter placment instead of the standard
ultrasound.

It turns out that treatment at NCI is experimental only.  They run
clinical trials.  They don't do off-the-shelf standard treatment.
However, because it's government paid for medical research,
it's also completely free!  Surprisingly, in spite of their advanced
capabilities and free treatment and proximity to Washington DC
where there are many uninsured people, they have trouble
getting enough patients for their clinical trials.  People are
afraid they will be laboratory rats.

There is another excellent place where I could be treated under my
insurance plan (Greater Baltimore Medical Center), but I've gotten
to like the science geeks at NCI and I'm going to try out the role
of lab rat for them.

   Alan