The information that I received from several doctors at UCLA is different than what your US doctor has told you. I am 77 Gleason 9 aggressive, CR. They recommended robo surgery because, radiation practically removes the option of surgery later, but surgery does not remove the option of radiation and surgery allows a better review of the prostrate and therefore a more complete diagnosis / treatment plan. Surgery is the gold standard. Surgery and radiation are equally effective for the initial treatment but after initial treatment the cancer often returns. I had surgery, one day in the hospital, one week with a catheter, continent, ER. Had 13 months of ADT and Erleada. I believe that I made the right choice. Good luck.

I believe you're likely getting good advice from different folks, it's just that there should probably be some fine tuning....

A) It's my understanding that if you get treated via radiation, and there is a recurrence, the surgery is very specialized and difficult at that point. Whereas if you get the surgery, and recurrence happens, radiation is the second treatment (likely with ADT meds) and there is often little or no damage from the radiation as it's at lesser levels than if it's the primary treatment. Ask your docs about this.

B) There may certainly be side effects from radiation, they just may not be a bad or long lasting as from surgery. (fatigue, damage to the colon is possible, diarrhea cramping etc.). They should subside a couple months after end of treatment. Some folks report no side effects, who knows for sure? It also depends on the type of radiation.

I can see both arguments. Part of the radiology argument might be coming from the perineural invasion. Some might say that taking prostate out at that point may be "shutting the barn door after the horse got out." BTW, I was unaware that they can make that determination from the biopsy, learn something every day. The fact that you are showing as a gleason 6 may also play into this. I might also want a bone scan and MRI to see you can find anything elsewhere.

FYI, I consulted a surgeon and a radiation oncologist before deciding, both said that if they were me they'd go with their specialty. So they both probably believe what they are doing is the best way to go about it. You'll have to educate yourself as best you can, (do a lot of reading here) and decide what's best for you and your family.

Was the radiologists just that or a radiation oncologists? I'd be seeking the advice of the latter.

I ended up with surgery followed by salvage radiation therapy. I also had perineural invasion but it wasn't discovered until the pathology report after surgery.
Just some thoughts.
Best of luck to you!

This choice seems more and more confusing for me. My urologist told me the following: Gleason 8 or less, surgery is probably better. Gleason 9 or 10, radiation is better, because surgery might accidentally spread the cancer.

I was Gleason 9, and got radiation. Was it the right choice? Ask me in a decade or two.

Suggestion:

Book Surviving Prostate Cancer by Patrick Walsh, MD

Download or hard copy (both free) Patient Guide from Prostate Cancer Foundation pcf.org

Best wishes.

Deciding on treatment for prostate cancer (PCa) is complicated. And it's not a trivial decision... your choices can have life-long effects.

The good news is, PCa can be successfully treated with surgery and/or radiation -- with excellent long-term survival rates -- especially if you're treated by experienced doctors at a Center of Excellence.

Best advice I got from my Urologist was to do extensive research. That is, with PCa there are no short-cuts to making a WELL-INFORMED decision. You've got to educate yourself.

As already mentioned, Walsh's book "Surviving Prostate Cancer" is excellent. Get the 5th edition, it's the latest.

And there are many many educational videos from reputable sources. Like this:

Diagnosed at 72, Gleasons of 3+4’s and 4+3’s, I read Dr Walsh’s book and researched lots at sites like Mayo Clinic, Cleveland Clinic, Johns Hopkins and more. I chose RALP as radiation after surgery is a viable option where the opposite is NOT the case. After I explained all my thoughts to my Urologist, he told me that he would have made the same decision.

I did Kegel PT with a DPT before and after the surgery, I was 100% continent after the surgery. The post-surgical pathology report showed a type of cancer that would have survived radiation.

Best of luck and come back with any questions.

I looked at all options, including removal and multiple types of radiation machines. I understood the risks of all of them. I chose a narrow margin, special type of radiation machine that limited the exposure of healthy tissue to radiation. I did not want to take the risks associated with surgery. NCCN.org is a source used and followed by many physicians, which is also open to patients , and is very helpful describing possible treatments for a different levels of cancer, including prostate.

I would suggest getting the decipher test which does, or can, change the treatment that the doctor chooses. The purpose of the test is to give you an idea of how aggressive the cancer is and it is easy to read. It uses the biopsy material which I have heard is good for up to a year.