You can add this to my previous offering of advice: Do not start or opt for radiation "first". When I wanted to discuss my options once I knew my Gleason Score, I asked about "active surveillance" vs radiation vs prostatectomy. My urologist was quite opinionated as follows: He said: "You 'HAVE' cancer...there is no point in active surveillance...you are just giving the cancer more time to spread and present more problems for the typical 2-year active surveillance timespan. I never recommend active surveillance unless the patient is barely a Gleason 6." Regarding radiation he said: "you never want to do radiation 'first', because that eliminates an optimal 'second' course of action. Radiation basically turns your prostate to a scarred, walnut-sized chunk of concrete. You can't have a complete and successful prostatectomy 'after' you have had radiation. It becomes extremely difficult to remove the scarred chunk of concrete. I know this for a fact because I know someone who did radiation first. His doctor told him that he is no longer a candidate for prostatectomy. He suffers massive pain at ever attempt to urinate, often which ends in not being able to actually void urine. "You do radiation 'after' prostatectomy, and only if/when needed - and hopefully you won't need it if the prostatectomy was thorough and successful." So, that left radial prostatectomy. With my Gleason score of 3+4 = 7 with just 6-10% of my cells being grade 4 in the second-pass microscopic examination, my urologist still was firm, saying: "I'm taking your prostate...it is your best option." So, I had the DaVinci Robotic-assisted Radical Prostatectomy. I am glad I did because the Gleason Score did not reveal what the surgical pathology report did on the entirety of my prostate tissue. I had EPE, surgical margins, Cribriform Glands, and left seminal vesicle invasion, all adding up to a more serious pT3b cancer category. So, my advice, based solely on my experience and my urologist's advice, is that "radiation first" is a bad decision if you later decide to have the prostatectomy. Go with prostatectomy "first", then radiation "if/when" you need it later.