Gleason 8 is aggressive, so you might end up on ADT anyway just to be safe. Many people have few to no side effects from radiation, and there's usually no pain or recovery time (of course, you can get unlucky, as I did). And the overall survival rate between prostatectomy and radiation are the same.

If you do choose surgery, try very hard to get the nerve-sparing kind. Not every facility can do it, but it could make a big difference for ED and incontinence.

Best of luck, whatever you choose!

Oh man…welcome to the most difficult decision you will ever have to make - with no backsies!
First of all there are no wrong decisions - outcomes for survival are the same. Both treatments have side effects so basically, pick your poison - as distasteful as that sounds.
At age 70 surgery is certainly a viable option but you better be sure you select an excellent surgeon - open surgery in these times seems a bit medieval but I am not a surgeon so perhaps there are reasons - but THAT is very invasive and a longer recovery than a robotic procedure.
OTOH, there are many options with radiation and not all of them take months - some just about 2 weeks.
However, with G8 you’d probably be placed on ADT for 6-12 months - longer if your RO feels the need.
I know I probably have not helped you much but after living in this PCa world for over 6 yrs (surgery and then SRT with ADT) I’ve come to realize that even though ALL OF IT sucks you do manage to get through whatever brilliant decision you think you’ve made; and once you’ve made it, embrace it, put your blinders on and charge forward…NEVER, EVER look back!! Best,
Phil

Hello - thanks for sharing. When I opened the discussion of my "options" after receiving my 3+4=7 Gleason score (3 cores negative/normal, 3 cores "6", and 6 cores 3+4 with only 10% being "4"), I asked about Active Surveillance, Radiation, and Surgery. My Urologist said that if you do radiation first, you can never have a successful radical prostatectomy afterward. "The radiation therapy turns your prostate to concrete" he said. He was directive...adamant...saying: "I'm taking your prostate". I got the clear message that I had no choice. He also said/asked: "why would you want to wait two years with active surveillance, only to give your cancer two years to advance in staging and spreading beyond your prostate?" I understood that immediately. It sounds like active surveillance is suited only for people with 3+3=6 Gleason score...the lowest you can have. So, I had my single incision DaVinci Robotic Assisted Radical Prostatectomy on 4/18/25. Lots of frustrating, exasperating post-op consequences...mostly the urinary incontinence and a complete change in bowel habits. Because I fell into the unlucky 10-20% that have "surgical margins" (he didn't get "all" of the cancer...left some behind), I need to have a discussion of having radiation anyway, to have a focus kill of the remaining tissue. Good luck, but I would stay away from radiation as your first choice option.