Given that your prostate cancer is aggressive, I personally would go with surgery versus radiation. Please note, I had no other comorbidities, was healthy, and 55 years old when I was initially diagnosed with prostate cancer (Gleason Score 7 - 4/3). There are possible complications with both radiation and surgery, but surgery allows you to physically define margins (excellent for medical team moving forward), removes all known cancer (including cancer not yet identified that remains in the prostate & seminal vesicles), and leaves more options on the table if the cancer returns (a radical prostatectomy is very difficult, if not impossible, after radiation).

I have heard the nightmare scenarios with all treatment plans (surgery, radiation, hormone therapy, active surveillance, etc.). What I have learned - Every man is unique, must evaluate their personal situation, and make a decision on a treatment plan that aligns with his life expectations. For myself, I wanted 30+ years of PC free life to spend with my wife, family, and friends. Given my health and age, the radical prostatectomy was a "no-brainer". However, given another man's situation or personal research/opinions, radiation/hormone therapy could be the "no-brainer" decision. Either way you go, you need embrace your decision, accept the consequences, and keep fighting. Second guessing only causes you stress and anxiety.

One point that is an absolute, you must go to a center of excellence for whatever treatment plan you choose (and then do research to find the best possible doctor). For myself, that was Mayo-Rochester with Dr. Igor Frank for the radical prostatectomy. Amazing doctor, staff, and hospital. Rochester was definitely not the closest option, but I am so glad I went with this center of excellence!!

Good luck and hope all goes well with your treatment plan!!!

Jim