I'm not going to try to answer what is the "best treatment course" for you; but, I'll help offer guidance and answer questions along the way to help you decide what might be best for yourself. Some of the treatment modes seem to have evangelists who's personal mission it is to "sell, sell, sell" whatever mode they chose for themselves. I won't do that do you.
The advice I have for starters is to get yourself some of the very solid reference materials...you will use it now, while in educating/decision-mode, and later during treatment and beyond. Look for the book (online booksellers) "A Primer on Prostate Cancer: An Empowered Patient's Guide" by Dr Stephen Strum. That's what you want to be...an empowered patient! You will do that by educating yourself about prostate cancer, and what the pros and cons are of each treatment mode. In general terms, you will find cancer control for surgery and radiation to be roughly the same (and very high levels of control) for the very commonly occurring low risk cases, and the side effects net out to be very similar...with an inverse impact curve (that is, radiation has almost no side effects short-term but tends to have longer term and consequential effects down the road, whereas surgery side effects are immediate but tend to diminish over months) You own personality may play into how you want to address these effects...so, there really is no "one size fits all" best treatment course.
Best first step: order the book; you will want reliable resources to educate yourself.
Also, in order to offer further help, I might suggest that you also reply back with the rest of your key clinical information: DRE results, how many biopsy cores were found to be positive, what percentage of cancer in each core, what is your past PSA history (dates & results), was your Gleason 3+4 or 4+3...
Kcon gave you some good advice; it's your decision and you have to do your own research.
The key to a successful treatment is to gain alot of knowledge about your particular cancer. Is it agressive or truely intermediate. What is the exact location of your tumor and what is its size. Is it at the margin or has it pierced the margin. Is there possibility of nerve or seminal vesicle involvement. An MRIS or Color Doppler Ultrasound can answer some of these questions. If the tumor is in the transition zone, it is a difficult surgery, if at the Apex there is a higher possibility of a positive margin. If nerves or seminal vessicles are involved then surgery may not be the best choice. What do the partin tables show as a probability of it being organ confined.
Many patiens rush into surgery without knowing this information and end up doing salvage radiation.
As far as side affects are concerned brachytherapy or brachytherapy combined with IMRT generally has the least side affects and long impact on quality of life than surgery.
Surgery has the advantage if you have urinary issues or a very large prostate and may be more appropriate for young men.
Welcome to the board! There have been three good responses as I'm seeing your thread at this time. I would like to underscore the value of the Strum/Pogliano book - very useful for tailoring the therapy options to the patient.
Originally Posted by william65
i would like to know the best treatment course, I'm 65
PSA of 5.4 and a gleason score of 7 in good health otherwise
I believe you will also learn from a recent report from the Prostate Cancer Results Study Group. There is a thread about it entitled "Choosing a therapy - lessons from the Prostate Cancer Results Study Group," started May 22, 2010.
If you want to go straight to the research horse's mouth, try searching www.pubmed.gov, a site we can use on this board because it is Government sponsored. You can do a search like (without the quotation marks) " brachytherapy AND prostate cancer "; try substituting other kinds of therapy for brachytherapy. You can add " AND side effects " to focus more in that area. When you get the results list, clicking on the hypertext title will get you to the free abstract of the study, if there is one. Sometimes you get a free link to the entire study.
Don't forget to learn about lifestyle tactics to combat prostate cancer. It appears that diet, nutrition, supplements, exercise and stress reduction can be quite helpful to our cause. You can search PubMed about them too.