I'm a practicing gastroenterologist in Ohio. That means that I'm not naive about prostate cancer, but having spent my life in an unrelated specialty, I didn't truly know much more about the disease than most patients. The advantage I did have was in being a patient of an absolutely superb urologist.
My PSA was found to be 3.8 in the Fall of 2006. That didn't alarm me greatly because it was normal, but the velocity of the change was alarming enough to make my urologist postpone the TURP (Trans Urethral Resection of the Prostate) he was scheduling in order to do biopsies first. Only one of 22 was positive, but that's enough to yield a Gleason score of 6. I did less than exhaustive research on my own because I had complete and total faith in my doctor. He practices at a hospital that adopted robotic surgery early, and he was qualified to perform the surgery that way. However, he advised me to have a standard open prostatectomy. That's what we did in January 2007. The night after surgery was one of the rougher ones of my life, but things got better exponentially after that. I was asked to bring adult diapers to the office when I had my catheter removed on post-op day 9, but I never experienced a drop of incontinence. Erections didn't come immediately, but a little Cialis two weeks after surgery gave a totally firm and durable erection. Within another week or two, the drug was unnecessary, but I kind of liked it so I continued using it for several months on the assumption that anything that promotes blood flow would improve short and long-term results. I believe that sex has been, perhaps, a little better since my prostatectomy because it lasts longer. I was plagued by a bit of a "short fuse" pre-operatively, and that's not been as much of a problem since then.
I had a significant scare when a PSA value was returned as 0.03 18 months post-op, but it was a lab glitch, and all the rest of them have been undetectable for the following 2+ years. I'm almost four years post-op now, and I've only recently been able to receive my PSA results without having palpitations. I've finally started to take life more than "one month at a time."
I think the take-home advice I want to leave here, and this is just one of many opinions, is to find the best urologist you can, one you'd readily trust with your life (for that's what you're doing) and then follow his recommendation on what kind of treatment to pursue. This is not to say that I'd recommend against educating yourself to the fullest, but having a surgeon who's been through this over a thousand times before can be invaluable.
I'm in my 8th year following radical prostatectomy. I never had any side effects other than ED for about a week after my catheter was removed, and I don't think that should even count.
My PSA has been undetectable from the start. For me, surgery was very, very clearly the correct choice of treatment.
I'm now almost 9 years status-post radical prostatectomy, and my PSA remains undetectable. I have no side effects of the surgery and never did have. I was extremely lucky in all ways. My Urologist still asks me to drop in once a year for a PSA, but that's the only way my prostate cancer has even inconvenienced me since the operation.
The only downside is that my recovery and cure have been so uneventful that it's diminished my empathy for fellow cancer fighters. I'm thankful that I got a request to update my my YANA story, because it's led me to pause and reflect a little on my good fortune. I'll resolve to spend more time giving back to the medical community.
In 4 months, I will be 10 years S/P radical prostatectomy. My PSA has remained undetectable. I have no symptoms and no side effects of surgery. The treatment modality I elected is not for everyone, but the outcome for me was absolutely perfect, one of the most significant blessings of my whole life. In retrospect, I wouldn't change a thing.
I'm now approximately 11 years S/P standard prostatectomy for my Gleason-6 prostate CA. I've never had incontinence, impotence, pain, or inadequate flow. I continue at 11 years with an undetectable PSA.
One cannot know what might have happened with less aggressive treatment, but with the advantage of 11 years of hindsight, I'm very thankful that my therapy proceeded exactly as it did.
To repeat my advice in a nutshell: endeavor to find a very experienced urologist in whom you have completed faith and do what he recommends. Educate yourself maximally, but heed the urologist, too.