I suggest going straight to the radical prostatectomy. People sometimes get hung up on the word "radical"...it carries a negative connotation. Radical only means "complete", as opposed to "partial." Semantics aside, "if" you decide on radiation first (I do NOT recommend), go for Proton Beam Therapy, not traditional radiation therapy. That will give you a better chance post-therapy to have the radical prostatectomy without difficulty or consequence. If you have traditional radiation therapy, your prostate will be - as my urologist said - "a scarred lump of walnut sized concrete that is very difficult to remove in its entirety." Proton Beam Therapy offers the better option because the radiation oncologist can focus the proton beam at your prostate and the proton beam will only go "to", but not "through" the prostate. There is no damage to other surrounding tissue like the bladder, bladder neck, urethra, rectum as occurs with traditional radiation therapy that not only goes "to" the targeted prostate, but also goes "through" and irradiates normal healthy tissue. In my first consult with a radiation oncologist, he told me flat out...unsolicited...that traditional radiation therapy has a nearly 100% guarantee of making you have urinary incontinence for the rest of your life...because it irradiates and damages your bladder and urethra. That is a HARD, flat-out NO for me, as a post-prostatectomy patient who has struggled to regain 98% of my urinary continence. That will not happen with Proton Beam Therapy (*guys please chime in if you have urinary incontinence after Proton Beam Therapy whether you still have your prostate or if it was removed). Good luck - let us know what you decide, and how you progress.