While waiting for my biopsy results, I did scare myself by doing a bit of research on treatments.  Many alternatives exist.  The most proven one is an open radical prostatectomy or RP.  In the hands of a very experienced surgeon, this method has the best long term cure rates and among the best success rates for long term incontinence and impotence, too.  A handful of experienced surgeons across the country have done thousands of these surgeries, including the nerve-sparing procedure for those with early stage cancer.

This isn’t to say open RP is the best treatment for everyone.  There’s a robotic procedure (RRP or DaVinci) that is gaining popularity.  It’s too new for long term results, but it looks to be similar to that of the open procedure if you can find a very experienced surgeon.  Again, from my research, the choice of an experienced surgeon appears to be at least as important as the choice of which surgery to have.  A surgeon that has done hundreds, if not thousands, of the same procedure is ideal.  Even better is one who has published results or at least one who will share detailed  statistics on their results with you.  Another thing to ask is for referrals to patients who have had a “trifecta”.  That’s the term for a long term cure of prostate cancer with no long term urinary or sexual issues (be careful on how a surgeon defines incontinence and impotence).  If you’d ask for referrals on home contractors, you should absolutely do the same for someone about to cut you open!

Radical prostatectomy, open or robotic, is a major surgery.  They don’t just remove the prostate.  In the process, they have to cut and remove part of the urethra and the neck of the bladder, along with the internal sphincter that helps control urination.  If the cancer is not widespread, many surgeons are able to spare the nerves associated with sexual function, but there can still be trauma.  You’re almost guaranteed a hospital stay of a couple days or more, a catheter for maybe a week or so and some degree of incontinence and impotence for at least some time (perhaps months, a year or forever).

There are also radiation, hormone and other treatments like high intensity focused ultrasound (HIFU) and cryoablation.  Being younger and more likely to tolerate surgery with good results, I didn’t really consider these more than learning about them.  Some of these are recommended in specific situations, while others have much lower proven cure rates.  Being 40,I did look into radiation treatments, but almost none seemed to have the proven track record as open RP surgery.  I did find one exception, dubbed “ProstRcision” by the center in Atlanta that does this combination of radiation seed therapy and external beam therapy.  They not only have a long term track record, but they claim their results are on par with the best surgeons, probably better in terms of incontinence and impotence.  It’s definitely worth a look if you can spend 6 weeks in the area for treatments.

I really don’t want to promote or attack any particular form of therapy.  In fact, some very interesting new techniques are on the way, such as “cyberknife” or improved mapping that will allow a less invasive “male lumpectomy”, rather than complete prostate removal.   This would be like having a breast lumpectomy for a localized, less aggressive tumor, rather than a total mastectomy.  These newer procedures may also offer reduced incidence or severity of side effects, but their long term cancer cure rates are unknown.  For the patient, the problem is that most urologists only specialize in one form of treatment, so they will each have a bias.  Certainly, all these therapies are valid and some situations may make one a much better choice than the others.  My main point is that regardless of what treatment you choose, the surgeon or oncologist is probably the most important aspect.  Find one you trust, who is experienced, has proven long term results and is willing to put you in touch with other patients.