Sy,

Welcome the club no one asked to join.

'Tis time for you to take the bull by the horns and do some.... no, a lot!
... of research.  We have a great bunch of guys here who will answer any
questions you put to us, but your life is in your hands and you will have to
be making a huge decision soon.

Some the of criteria that goes into such a decision includes your age and
physical well-being.  If you are older than 70, maybe that prostatectomy is
'no way.'  If you're less than 50, prostatectomy is WAY!  There is a good
age range for brachy and there is an age at which you probably can only
consider hormones.

Personally, if my body could take it (and most can now up to 75), I would
opt for the robotic laparoscopic prostatectomy, but we don't have enough of
your stats to even come up with an opinion.

I am one of the very few here that has cyberknife equivalent (Elekta
Synergy S) and high-dose too. I enrolled in a treatment study and so
far so good. The only SE is grade 1 rectal bleeding (ocasional and
persistent (6 months, and still have occasional blood stripped stool).
No problem with urinary or erection. PSA slowly going in a downward
trend, and I did not use any hormone treatment.

Listen, read and consider all of this information. These guys have
been the most helpful resource to me over the past several months.

Sy wrote and asked:

I had an appointment - stressed "seeds" when making it - with a urologist.

The only thing he talked about was the CyberKnife.  Handed the wife and me a
small pile of literature and URL's.

Turned out the URL's were directly to CyberKnife and its press released,
thumping its own chest about the marvels of the machine.

The press release that stunned the wife and me stated CyberKnife was
developed for brain tumors, and later approved by the FDA for breast cancer.
It has only been recently approved for treatment of PCa.

AND, the local CyberKnife this urologist wanted to send me to had been
installed only the week before.  I was possibly the first victim....er,
patient.

This was all in June 2005.  I have no idea how many men have been treated
with CyberKnife in 2 or 3 years, but there just isn't enough data to prove
it's more or less effective than older methods.

OH!   The literature states it's "non-invasive" but somehow they have to
plant "marker seed" in the prostate.

Like you, my reaction to surgery was "no way".  I had once had a
botched knee surgery that left me in pain for years and my
emotional reaction to another surgery was - never again would I
let someone put me to sleep and then cut me open, unless there
was no other choice.  I opted for a combination therapy in a
clinical trial including ADT, high dose rate brachytherapy, and
external beam radiation.

So far, 3-1/2 years later, I'm satisfied with my treatment.  That
might change if my PSA goes up.  However I've learned a lot more
since then and I no longer have the same visceral reaction
against surgery that I had at the beginning.  Unfortunately,
there are butchers in every field, radiation oncology as well as
surgery.  So you could have a bad experience with any treatment
modality.  There is also a certain element of luck in any
treatment.  That too can lead to unfortunate results.

In my (in this case informed I think) opinion, the experience,
skill and commitment of the practitioner is every bit as
important as the specific treatment modality.  I think I'd rather
have a very good surgeon than a mediocre radiation oncologist,
and vice versa for a good radiation oncologist and a mediocre
surgeon.

You've got some time.  Your PSA and Gleason ratings are still in
the "low risk" category and may not become dangerous for as long
as several years (but heed Steve Jordan's advice about a second
opinion on the Gleason score.)  This doesn't mean you shouldn't
get treatment because, at your age, it's very likely that the
cancer WILL become dangerous before you die of something else and
the chances of successful treatment are generally higher with
early treatment than late treatment.  However you do have time to
research and think out the options.

I think you have two areas of research to pursue.  One is to look
at treatment modalities - various types of surgery vs. various
types of radiation (of which Cyberknife is one) or possibly even
other alternatives like HIFU or cryosurgery.  The other area of
research is to find the best practitioners available to you.

I would look for a doctor that specializes in treating prostate
cancer (not a urologist whose specialty is female incontinence,
or a radiation oncologist whose specialty is brain cancer.)  I
would want a guy who answers questions patiently, plausibly and
honestly, not one who gives glib answers like "None of my
patients develop incontinence", "My cure rate is 99%" or "Don't
worry about impotence, it won't happen".

Talk to doctors and nurses in your area if you can and find out
who they would send their fathers or husbands to.  Make
appointments for consultations with the best people you can find.
Prepare a ton of written questions and bring your notebook with
you when you go to see them.

Best of luck.

   Alan

I can't say a thing about cyberknife for PC but I had it done for something
entirely different. I had neurosurgery this spring and they used cyberknife.
You are welcome to email me about what I had done as it would be off topic
for this group.

I do know that cyberknife for PC is new. Real cutting edge technology (LOL)
there's no cyber or knife in cyberknife. It's about the same as looking for
the ham in hamburger.

I'll stand behind brachytherapy 100%. I know it works.
Bev