THE DECISION

There Was No Simple Answer

Once the words “You have prostate cancer” had started to sink in, another reality showed up almost immediately.

We had to decide what to do about it.

I think part of me expected that once the diagnosis was confirmed, someone would simply tell me what the answer was.

Do this.

This is the treatment.

This is the path.

Instead, what Sue and I discovered was a decision filled with probabilities, tradeoffs, risks, opinions, and questions.

Surgery.

Radiation.

Hormone treatment.

Combinations of treatments.

There were legitimate approaches to consider, and each one came with its own potential benefits, side effects, uncertainties, and consequences.

I wanted an answer.

What I got was a decision.

What We Knew at the Time

The biopsy had already told us that we were dealing with aggressive prostate cancer.

One area showed Gleason 4+3=7.

Another showed Gleason 4+5=9, Grade Group 5.

The pathology also included findings such as cribriform morphology and perineural invasion.

Those findings mattered because they shaped the seriousness of the conversations we were having.

Then, on February 11, 2026, I had a PSMA PET/CT.

The scan showed two areas of disease within the prostate.

It did not show obvious lymph-node metastasis.

It did not show distant metastatic disease.

At that point in the journey, that information was encouraging.

It appeared that we were still dealing with disease that might be contained to the prostate.

But one of the things I had not fully learned yet was that imaging gives you information.

It does not necessarily give you every piece of information.

I Wanted to Know Which Treatment Was “Best”

That was probably the question I wanted answered most.

Which treatment is best?

The problem was that the question was more complicated than I wanted it to be.

Best for cancer control?

Best for urinary function?

Best for sexual function?

Best for recovery?

Best if additional treatment became necessary later?

Best for a 59-year-old man with my biopsy findings, my health, my priorities, and my tolerance for risk?

Suddenly, “best” was not one question.

It was a collection of questions.

Research Was Helpful — But It Wasn’t the Decision

I researched.

I listened to doctors.

I read about surgery.

I read about radiation.

I listened to other patients describe what they had chosen and what happened afterward.

All of that was useful.

But I eventually realized that I needed to keep four things separate in my mind:

• What does the research say?
• What is my physician recommending?
• What happened to another patient?
• What matters specifically to me?

Those are related questions.

They are not the same question.

Someone else’s experience can teach me something.

It cannot tell me exactly what my experience will be.

A study can give me probabilities.

It cannot promise my individual outcome.

A doctor can recommend a treatment based on expertise and experience.

I still have to understand what that recommendation means for my life.

The Quality-of-Life Questions Were Real

When people talk about cancer treatment, the conversation understandably begins with controlling the cancer.

That was the priority for me too.

But treatment does not happen to a cancer cell in isolation.

It happens to a person.

So I also needed to understand questions about:

• Urinary continence
• Sexual function
• Recovery time
• Potential side effects
• Future treatment possibilities
• What everyday life might look like afterward

Those questions were not superficial.

They were part of making an informed decision.

Choosing a cancer treatment did not mean pretending quality of life did not matter.

It meant trying to understand the tradeoffs as clearly as I could.

Radiation Had Questions Too

One thing I want to be clear about is that this was not a story where surgery had risks and radiation somehow did not.

Every treatment discussion required questions.

If I was considering surgery, I needed to understand:

• What the procedure involved
• What recovery might look like
• Potential urinary effects
• Potential sexual side effects
• What would happen if pathology showed more disease than expected

If I was considering radiation, I needed to understand its potential side effects, treatment schedule, risks, and what life might look like during and after treatment.

The treatment was different.

The questions were still necessary.

The need to understand was the same.

And Then There Was Plan B

One of the most useful questions I began asking was not only:

What happens if this works?

It was:

What happens if it doesn’t?

Or maybe more accurately:

What happens if this treatment is not enough?

That question mattered to me.

If I chose one path, what options might remain available afterward?

If additional treatment became necessary, what might that look like?

What would cause the plan to change?

What information would we learn from the treatment itself?

I was beginning to understand that treatment decisions are not always simply about choosing Plan A.

Sometimes understanding Plan B is part of choosing Plan A.

Why I Chose Surgery

After consultations, research, conversations with Sue, and more questions than I can count, I chose a robotic-assisted radical prostatectomy.

I want to be careful about how I say that.

I chose surgery.

That does not mean I believe every man with prostate cancer should choose surgery.

It does not mean radiation would have been the wrong decision for someone else.

And it certainly does not mean there is one universal treatment choice that fits every patient.

This was my decision based on:

• My disease
• My age
• My health
• My priorities
• My understanding of the risks
• My own tolerance for uncertainty

For Me, Surgery Felt Concrete

There was also something about surgery that made sense to me emotionally.

My thinking was remarkably simple:

Cancer in prostate.
Remove prostate.
Hope the cancer comes with it.

I understood that reality was more complicated than that.

No one promised me that removing the prostate guaranteed the cancer was contained.

No one promised that surgery meant I would never need another treatment.

No one promised a particular outcome.

But for me, surgery felt concrete.

It also offered something else that mattered to me:

The prostate would be removed and examined.

We would get full surgical pathology.

We would learn more about what we were actually dealing with.

I Understood That Surgery Had Tradeoffs

Choosing surgery did not mean I was unaware of the potential consequences.

We talked about recovery.

We talked about urinary continence.

We talked about sexual function.

We talked about the possibility that surgery might not be the final treatment.

Those conversations were uncomfortable.

They were also necessary.

I did not want to make a permanent treatment decision based only on what I hoped would happen.

I wanted to understand what could happen too.

Sue Was Part of the Decision

This was happening to my body.

But it was happening to our life.

Sue and I talked about the options together.

We talked about the cancer.

We talked about recovery.

We talked about side effects.

We talked about what life might look like after treatment.

There were things only I could ultimately decide because it was my body.

But I was not making the decision in a vacuum.

Whatever happened next would affect both of us.

That made Sue more than someone I informed about the decision.

She was part of how I worked through it.

Another Opinion Is Not an Insult

One thing I became more comfortable with during this process was the idea of gathering more than one perspective.

Asking another physician for an opinion does not automatically mean you distrust the first one.

Sometimes it helps confirm the recommendation.

Sometimes it raises a question you had not considered.

Sometimes hearing the same information explained differently makes it easier to understand.

When the decision is irreversible and the consequences matter, I believe it is reasonable to gather enough information to feel confident that you understand the road you are choosing.

Questions I Would Take Into a Treatment Decision Today

Looking back, these are some of the questions I would want in front of me before making a major treatment decision:

1. What is the primary goal of this treatment in my specific case?

2. What information about my cancer is driving this recommendation?

3. What are the other reasonable treatment options I should understand?

4. What are the major short-term and long-term side effects?

5. How could this treatment affect continence, sexual function, recovery, and everyday quality of life?

6. What does the imaging tell us, and what might it not be able to tell us?

7. If this treatment is not enough, what might Plan B look like?

8. What would cause you to recommend a different approach?

9. Would another specialist’s opinion add anything useful before I decide?

10. What question am I not asking that you think I should understand?

Making a Decision Did Not Make the Uncertainty Disappear

I wish I could say that once I chose surgery, all the uncertainty disappeared.

It didn’t.

Choosing a path does not guarantee where that path leads.

There were still unknowns.

What would the surgery find?

What would the full pathology show?

Would the cancer truly be contained?

What would recovery look like?

Would additional treatment eventually be necessary?

We did not have those answers yet.

What we had was a decision we believed made sense based on the information available to us at the time.

The Decision Was Mine — But It Was Not a Recommendation

This may be the most important thing I can say about this Mile Marker:

I am telling you what I chose, not what you should choose.

Someone else may look at similar options and reasonably make a different decision.

Their priorities may be different.

Their health may be different.

Their cancer may be different.

Their tolerance for particular side effects or risks may be different.

Their physicians may have information that changes the conversation.

That is why I have become so cautious about telling another patient what they “should” do.

I can tell you what happened to me.

I can tell you what I asked.

I can tell you what I wish I had understood sooner.

But your decision needs to belong to you and your healthcare team.

What I Hope You Take From This Mile Marker

If you are facing a major treatment decision, I hope you give yourself permission to ask as many questions as you need.

Understand what your doctors are recommending.

Understand why.

Understand the alternatives.

Understand the potential side effects and tradeoffs.

Think about what matters most to you.

Ask what happens if the first plan is not enough.

And if another opinion would help you understand the decision more clearly, do not be afraid to seek one.

I chose surgery.

It was the decision that made sense to me with the information we had at the time.

The next Mile Marker would teach us just how much more there was still to learn.

And So…The Adventure Continues.