One of the understandings I had with my doctors was that quality-of-life and successful treatment were of equal priority for me. That set the basis for us working together and ultimately agreeing on a treatment plan.

> You’ll have to establish your own priorities in making this decision.

With success rates comparing surgery with external radiation for localized prostate cancer being statistically equivalent no matter which treatment is chosen (https://www.nejm.org/doi/full/10.1056/NEJMoa2214122), it all comes down to side-effects and quality-of-life (or as that paper concludes, “… the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer.”).

Based on my priorities and my understanding of each treatment’s side-effect profile, (at 65y with a localized 7(4+3) w/PSA of 7.976) I decided on 28 sessions of proton radiation (during April-May 2021), with 6 months of Eligard.

For me, that decision has worked out well. Quality of life was fully maintained and my most recent PSA test was 0.366.
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Regarding your urinary issues:
> are you on either Tamsulosin (Flomax) or Finasteride?
> in preparation for radiation, the ADT that’s given for a 4+3 shrinks the prostate; sometimes that reduces urinary issues.
> radiation itself also shrinks the prostate; sometimes that reduces urinary issues as well.

Lots of decisions to make; and much to discuss with your medical team so that your personal priorities are maintained.