Hey TM91, Could you please tell us your age? Sometimes it is a huge factor in which treatment you select.
Gleason 9 is considered aggressive; paired with a high Decipher score could be an indication of an even more aggressive disease. But even a lower Decipher score (below .5) does not mean all that much once you are a G9.
All the specialists - radiologists or surgeons- will tell you that your disease has a higher chance of recurring than in someone with a Gleason 6. With that in mind it is usually recommended that you go with surgery as your primary treatment; if your cancer recurs, it can then be treated with radiation and hormone therapy (ADT).
The reverse, radiation first and surgery later, can also be done but is much more complicated due to radiation scar tissue and only a few highly specialized surgeons do this.
The reason I go thru this long winded spiel is this: if you are young - mid 50’s to low 60’s - surgery is probably the option I would choose (and did). If you are in your upper 60’s or older, or in not such great health, radiation becomes more attractive simply on an actuarial basis - how long you might live - or die from something else before your cancer returns.
Yeah, it’s somewhat dry and analytical but that’s how you have to think when making these important choices. As stated, I was a Gleason 7 unfavorable and chose surgery because of its chance to recur. 5 years later, it did, and I just completed radiation and ADT treatment with fingers crossed. So I got my second chance and hopefully will not have to try for a third🤞. Best of luck!
Phil