@keithl56 For localized disease, data show that success rates comparing surgery vs radiation are statistically equivalent.
> https://www.nejm.org/doi/full/10.1056/NEJMoa2214122

As that paper concludes, “… the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer.”

So, it basically comes down to one’s quality of life priorities. For me, that clearly placed radiation at the top for primary treatment (and I chose proton radiation).

Also, if (heaven forbid!) I ever needed salvage treatment, primary radiation would leave me with the most options.
> For those who choose primary surgery, if there is recurrence the first salvage choice is radiation - the very thing they wanted to absolutely avoid at all costs.
> For those who choose primary radiation, if there is recurrence there are many salvage options - focal therapy (e.g., cryo), brachytherapy, and SBRT (because they’re all very targetable), and yes even re-radiation in some cases; salvage surgery is a last and distant option (if at all).

Much goes into this treatment decision beyond just “get it out”, with one’s personal quality of life priorities being a major factor.