For a number of reasons my husband and I chose surgery first; we knew people who were cancer-free after this procedure, and failure of surgical treatment was recoverable through radiation. This was not the case the other way around - failure of radiation could not be recovered by surgery.
As it turns out, having the surgery first was a good decision. The tumor had extended through the prostate capsule, making it a very difficult surgery, and the result was a "questionable margin" - an edge where it was not clear that all cancer cells had been removed.
However, all the cancer had apparently NOT been cut out, because two years later my husband's PSA levels began to rise.
We went immediately into radiation at Johns Hopkins. There, the was radioactive beam was focussed so well by sophisticated calculations that little surrounding tissue was damaged. My husband's was a textbook case with no side effects except a little rectal pain and bleeding. My husband's post-radiation PSA dropped quickly to zero, and has stayed there to this date (more than 4 years).
The most important lesson from this experience was not the choice of treatment type however; it is the QUALITY of that treatment. We saw two urologists here in our small town of Logan, Utah, and had we not chosen to go to Johns Hopkins, I am convinced that the local surgeon, (who's estimate of the tumor's size and malignancy changed with the news that we were considering Johns Hopkins, and who insisted that he could do as well with only a fraction of the experience) would have left my husband incontinent, like some of his other patients. The second urologist we saw, recommended chemical emasculation first, insisting that this delay (not cure) of the disease would be as acceptable for my 52-year old husband as it was to his patients in their 80s.
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