THE WAY FORWARD

My "new" urologist turned out to be a pragmatic,younger doctor,prepared to allow me some say in the way forward.
He assessed (with me) all of the data including such aspects as:

~PSA
~CALCULATED DOUBLING TIME
~FREE PSA
~THE FACT THAT NOTHING WAS PHYSICALLY APPARENT FROM DRE
~LACK OF SYMPTOMS

and arrived at the conclusion that i could remain on "active surveillance" whilst i sorted my mind out and attempted to make an informed decision on the way forward regarding treatment (if any).
No pressure to act immediately,and a totally open mind on the form of treatment if/when the time came.
At this stage my PSA was hovering around 7 and slowly (well not so slowly) rising at a rate of about 1,0/annum,a growth rate which had been occuring for the past 4 years.
My calculated PSA doubling time was still acceptable and varied between 2,5 to 4 years (anything below 12 months indicates aggressive growth)
We agreed that we'd keep a constant check (3 monthly PSA) on my PSA ,with an understanding that treatment would need to be a serious consideration when:

~my PSA approached 10.....or
~my doubling time started reducing
~a DRE indicated a tumour about to migrate

Since being diagnosed I had read much about proton therapy,a very expensive treatment method only available in the USA (approx R1,5m) or in Prague (R0,5m) and ,in fact "popped in" on an eastern Europe bike trip in 2015,when my PSA had by now reached 8,0.
I'd made an appointment with the head of the hospital and was extremely impressed by what I'd experienced and the level of attention afforded patients in this institution.

PRAGUE

PRAGUE

Proton therapy is a very accurate form of external beam radiation therapy which appears to offer a radiation based treatment with far less collateral damage to surrounding organs and healthy tissue,achieving a similar success rate to any other.
My latest urologist (unlike my previous one) fully supported my efforts to obtain assistance from my medical plan for this treatment,if I so chose.
On returning home I attempted to gain sponsorship,through my health plan, to travel to Prague for treatment,but was flatly refused.
So.........back to the drawing board!
I'd sort of concluded,through 2 years of reading /researching,that the next bet would most likely be either external beam radiation therapy (we have a modern facility in Cape Town)or brachytherapy.
A little more research was necessary!
Anything but RP!

PRAGUE TIMEPIECE

PRAGUE CENTRAL