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Rick,
My sense is that you see your situation quite sensibly and your plans are most appropriate. And I for one cannot point you in one direction or the other.
The cancer could be encapsulated still, somewhat outside the prostate but still in the local area, or with some metastatic progress that is not yet detectable. Given the likelihoods, you now focus on the best treatment possible for the second (local) possibility.
I might suggest that you take a strong, healthy diet approach in the interim to decrease the chances that there could be any progression while awaiting treatment.
I've no idea what SE is, but in your situation you probably need to make cancer treatment the primary objective and leave erection issues secondary.
I guess I was mainly wondering how valuable the post-surgery pathology is (e.g. lymph nodes) vs a proton radiation treatment followed by just watching PSA levels to make sure they don't rise.
I understand your concerns. I recently had my surgery and initially was told everything looked good and the cancer appeared to be contained. However, the pathology disclosed that the cancer had spread outside the prostate. I had positive margins and they found considerable cancer in the seminal vesicles. I am now looking at radiation and hormone therapy. None of this would have been known without the post-surgery pathology.
I can't tell you the best way to go, but I think the pathology report proved a very valuable test in my case. Good luck with your decision.
My cancer in the seminal vesicles was in the portion close to the prostate. According to the pathologist, it occupied a "moderate" amount of both seminals. Because of this they are now recommending both radiation and hormone therapy.
Supposedly, proton radiation zaps the part of the seminal vesicles nearest the prostate.
But during surgery, I understand that they usually remove the vesicles entirely, so it's interesting that they still want to do some kind of radiation and hormones, maybe just as insurance.
I just saw my Urologist yesterday - he seems very competent and with a lot of radical and da Vinci experience under his belt. Also, his patients that I've met (3 or 4) have all had good results.
But the proton radiation stories are also convincing.
If secondary radiation is needed, I'm wondering if combining two forms of radation (proton + photon) is as reliable or has better or worse side effects than the surgery + photon radiation combination.
I had a da Vinci followed by traditional radiation. My PCa was all in the gland but I needed radiation because the surgeon left some of it behind. If I had it all to do over again, I'd go with just the radiation.
But, I think this needs to be treated due to the size of the tumor and the Gleason 7 score.
Although I'm worried about the side effects of all the treatments (especially after reading some of the personal stories at this site), Watch and Wait is probably the only option that I'm not considering, at this point.
I personally feel that DaVinci is fine for simple low grade cases. May have some limitations however for more complicated ones which may be best tackled by using the "very" "very" best surgeon available and the Radical method. Good luck, I'm sure whatever route you choose to go will be the right one for you.
Like you, once I had heard the "C" word, watch and wait was not an option for me. Cancer runs in my father's family, and Dad had prostate cancer.
I finally narrowed treatment options down to three: IGRT (Image Guided Radiation Therapy), brachytherapy, or radical prostatectomy. Because cancer runs in my family and because radiation treatment would make surgical solutions to any future cancer in the lower abdomen difficult if not impossible, radical prostatectomy seemed to be the best choice at this time. Once we knew we were doing RP,we went looking for the best da Vinci surgeon we could find in a reasonable travel and found Luis Anglo here in St. Louis who did 300 tradition open procedures before moving over to the da Vinci robot, where he has done over 500 surgeries, now including mine.
I can't give you a recommendation of what the "best" answer is in your case. Ultimately we are left to make very personal decisions on how to treat our cancer. Continue to research, read, talk, and get recommendations. Hold out until you are absolutely satisfied that you have the best solution possible at the time. And then be at peace with your decision.
Rick
I'm currently doing the Hormone therapy and Radiation treatments. I was 48 yo when I was diagnoised in September of 2008 and had a PSA of 158. Seven months ago I had a Radical performed in which they took the prostate, both seminal visicles, and over 40+ lymph nodes. The Radiation and Hormone therapy that I'm currently doing is a clean up that I opted to go with. As far the sex life and incontinence good luck. I know each person is different, so remember no one will be able to predict your true out come. Read and educate your self that will hopefully help you make a better well informed decision. I just wanted to pass along my situation, that I'm currently dealing with. Reading others experiences has helped, but I've found that each person is different and especially when you bring in the Doctors.
My cancer was a T4 grade with spread to the seminal vesicles and pelvic floor. I was very lucky though, in that there was no spread to bones or lymph nodes. I had HT plus 37 RT treatments in 2005 and it seems to have been very successful. Here's the link to the story so far...
http://www.yananow.net/Mentors/GeorgeH.htm
Whatever you decide, may I wish you the very best of luck.