Deciding on treatment

I need help with a man's most difficult decision: what form of treatment to choose for prostate cancer. My details are as follows. Age: 69, Health: very good, no chronic conditions, not overweight or a smoker. Most recent PSA = 2.9, % free PSA = 12%. 12-needle biopsy staged at 7 (3+4) by 1 pathologist, and at 6 by a second. 5 positive areas, all on one side, no positive areas on other side. There is a palpable area on the one side with cancerous cells. The worst parts of my prostate are  the 2 lowest areas. My dilemma, not unique I know, is that after reading several books and looking at many internet sources, I am torn between choosing the surgical treatment (a nerve-sparing retropubic radical prostetectomy) and a very focussed conformal radiation treatment + seeds to be followed by hormonal treatment for 4 months to 2 yrs. Both of these treatments would be performed by very skilled and very experienced specialists at excellent hospitals. Each specialist recommends his modality of treatment, but says the other is a reasonable choice too!
I think I am a generally good risk for surgery, and can take the time for recovery. Of course I am attracted by the lesser down-time that radiation treatments involve. I know that you can't tell me what to do, but can you tell me what to consider as the benefits, risks and long-term considerations in making this decision? Is there something in my particualar case In terms of the best and current data, what are the differences in side-effects of the treatments for a patient like me? What are the long-term recurrence and survival data? What should I consider in weighing the pros and cons? I would greatly appreciate all the suggestions you can provide to help me with this excruciatingly difficult decision.

[Kevin Pho, MD]

To answer this question, I am going to paste an article from UptoDate, which provides answers to the questions you are asking.  

Patient information: Treatment for early prostate cancer

Eric A Klein, MD
Cleveland Clinic Foundation and Taussig Cancer Center

Prostate cancer is a malignancy of the prostate gland, an organ that forms a ring around the urethra (the tube that carries urine from the bladder to the outside of the body) near its connection to the bladder. Prostate cancer is the most common cancer affecting men. Every year, approximately 189,000 men are diagnosed with prostate cancer in the United States, and 30,200 die from this disease. Over the last decade, the increasing use of prostate cancer screening by measurement of blood levels of prostate-specific antigen (PSA) has led to more cases being diagnosed at an early stage, when the cancer is still restricted to the prostate gland, and highly curable.

There are three standard approaches to treating early prostate cancer: surgical removal of the prostate gland, radiation therapy with or without hormone therapy, and "watchful waiting," a term that describes the decision to delay definitive treatment while carefully monitoring the patient for evidence of progression or growth of the cancer. Hormone therapy has traditionally been reserved for men with advanced or metastatic prostate cancer, although new applications of hormonal therapy as a supplement to watchful waiting, surgery, or radiation show some promise.

The ultimate choice of treatment is dependent upon several factors.

   The likelihood that the prostate cancer is confined to the prostate gland and therefore, potentially curable

   A man's age and overall health, including any other medical conditions

   The outcomes and potential side effects associated with the different forms of treatment


Here we will discuss the pretreatment evaluation of men with early prostate cancer, and describe the available treatment options, outcomes from therapy, and treatment-related side effects.

PRETREATMENT EVALUATION

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