@ginger38314

The question you need to ask your radiologist, then, is what their plan is in terms of irradiating tissue outside the prostate gland. For example, do they recommend widening the target field to address potential spread just outside the gland? Do they plan to target any of the pelvic lymph nodes?

If you're not going to be irradiating outside the prostate, then you're not necessarily going to be addressing unseen spread. And if you are going to expand the radiation field, then that changes the side effect profile.

High-genomic risk cancers also sometimes exhibit what's known as radioresistence. That could increase the risk that the whole-gland radiation is less effective at eradicating the disease within the prostate than surgery would be.

You should discuss all this in depth with your care team when weighing the benefits of surgery vs. RT.