General update: we had our radiology consultation today. The radiologist was very knowledgeable and kind. We discussed how the technology has come along in terms of being able to target the radiation more precisely, reducing collateral damage. That said, there are no long term studies on the current techniques (since they are new), so it's difficult to say with certainty what the side effects will ultimately be, particularly long term.

The radiologist seemed certain that surgery would result in lost of potency. He also explained that my cancer seemed to be going up towards the seminal vesicle, rather than towards the rectum. This means than the rectal spacing gel could be used despite the fact that they only recently started considering usage of that for high risk cancers like mine. (The concern is that the gel ends up "pushing" cancer cells into the rectal wall, which is the opposite result of what the gel is meant to prevent.)

We remain intrigued by the possibility of more limited side effects of radiation, but it still feels like surgery is the way to go. At least the side effects are known (seems like radiation can be better but can also be worse, particularly long term). Plus I'm young. Plus having a surgeon go in there can yield more relevant information. We realize that there will likely be recurrence but the more narrowly targeted radiation for those "flares" can be far better handled than the broader radiation that would be required as a primary treatment.

The radiologist seemed clear that being on ADT gives us time to do our research and while I should have treatment by May or June, there's time to explore the alternatives. All of your comments and answers have been very helpful. Thank you.

I'm mindful of the one person in this thread whose friend had significant urinary issues after radiation - something the radiologist mentioned today as a possibility. Are there others that received radiation who have side effects (or lack thereof) to share?