It’s really a case of 6 of one , a half dozen of the other; both forms of treatment have success rates you can research and quantify.
The real question for me is in the Decipher score; while not glaringly high, it is still telling you that the G4 component is more aggressive. Remember, the ‘4’ does not indicate aggressiveness, but the number of anaplastic cells (ie more abnormal looking) relative to the less abnormal looking ones (G3). It is confusing and it IS the subject of debate from one pathologist to the next.
This is where the Decipher test really makes a difference - it doesn’t tell you how many abnormal cells you have, but how aggressive and possibly treatment resistant they might be.
Radiation is wonderful against PCa but does have some limitations in that it doesn’t always kill all the cancer cells. That’s where ADT comes in; hormones may reduce your recurrence rate from 2.7% to 1.3%?? Those numbers are small, but one represents TWICE the protection against recurrence.
A 6 month course of Orgovyx ‘won’t kill ya’ as my Urologist told me as I trembled at the thought of becoming a fat, eunuch with teats. Didn’t happen, and was just a minor inconvenience compared to surgery.
If I were in your shoes (and I’m not), knowing what I know now about tumor proximity to the capsule and the value of Decipher tests, I would opt for ADT (orgovyx - not lupron) as an added measure to weaken the ability of the cancer cells to repair the damage caused by radiation.
With a more aggressive PCa neither modality alone can kill the cells, but together their effect is more than additive - it is lethal. Best of Luck,
Phil