I can only share what I was told by nine different doctors across specialties: at 54 (my age), surgery will be recommended over radiation for a number of reasons:

• I'll be more likely to see problems from radiation in my life since many of those problems, such as new cancers, bladder problems, bowel problems and stomach problems, can take as long as 15-20 years to manifest.

• I'm able to recovery from surgery faster

• Radiation can still be an option after surgery if it comes back

• Removal allows a full analysis of the gland to determine how much cancer you really have and how bad it really is, it's the only way to know that

The moral of the story being that I was never recommended radiation at this age. It was given as an option, and all the radiation oncologists I talked to say they have guys my age getting radiation but it's rare because most doctors say not to and that the reason that younger guys go this path is because they fear the side effects of RARP, such as ED and incontinence and loss of ejaculate (the the last of which is a guaranteed side effect). I have neither ED nor incontinence.

Now you mention high risk, what is your Gleason and Decipher scores? I would think they still would want to take the prostate, even if they intend to zap you as soon as you are healed, but I don't know for certain.

Make of that what you will, but consider all the facts and talk to experts.