Re: DX in Michigan
It's amazing how stressful the decision process can be. We've all had to agonize over unknowns, the worst of which is the true state of our cancer. But picking a treatment and then a doctor to do it is nerve wracking. There are no really good clearinghouses for reliable information.
I hope you realize that, with the slow rate of growth of your cancer, as shown by your PSA increase, you have a lot of time to make the right decision. All the books you read advise, and rightly so, to take weeks or even months to make the right choices.
Speaking of books, there are several worth looking at. Your urologist will likely recommend Surviving Prostate Cancer, by Dr. Walsh, himself a urologist. If you've noticed my recent post titled "Mea Culpa," I recently read the book through. It is heavily biased toward surgery, but is otherwise an excellent reference work. It also is out-of-date, with new studies invalidating some conclusions and showing that other treatments are equally viable.
Three other popular books (and there are many more, as I'm sure you're aware) by medical oncologists are:
Beating Prostate Cancer, by Dr. Myers. Written by a doctor formerly with the National Institute of Health who himself suffered from a challenging case of prostate cancer, this book gives a hefty dose of optimism.
A Primer on Prostate Cancer, by Dr. Strum. He was one of the pioneers of triple hormone therapy. This book provides an excellent, in-depth introduction to prostate cancer, explaining all the tests in detail, with excellent color illustrations.
Invasion of the Prostate Snatchers, by Dr. Scholz, makes the case for active surveillance, where it makes sense. He is quite willing to bring out the heavy guns when it is necessary.
I would say these three books are slanted away from surgery, but they provide a nice balance to the bias found in most books on prostate cancer.
You may think I'm opposed to surgery myself. In fact, I had surgery. Of course, with Gleason 9 cancer, the chances for failure are much greater than for lower grade varieties. I had positive margins and the cancer was contained in the prostate; I had no incontinence and my ED isn't as bad as most folks. I'm really only opposed to surgery when the surgeon should know better -- when it is likely that there will be avoidable positive margins or the cancer has otherwise penetrated the prostate. Anyway, how I feel is pretty much irrelevant to you.
To find the best hospital/doctor for your chosen treatment, it couldn't hurt to come right out and ask folks here and on other forums. There are several prostate cancer forums, some much more active than this one, so ask around. You'll get some input.
As for coming back for post-treatment care, that shouldn't be a problem. Of course, you current urologist will likely decline to treat you if you go elsewhere for your surgery. Still, you can either go to another urologist if you require that kind of treatment, and general practitioners can handle the simple stuff. Medical oncologists can help you if you need further cancer treatment.
Best of luck with this complex decision.