@solar4ever

You left a lot of information out. I generally feel what I wrote below fits. It was written for somebody 68.

Are you a T2b?

How many cores had 3+4, how many total cores were taken?.

Were any of these things found in the biopsy intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

I just wrote this to someone else and it applies to you as well

The one thing I’m missing is your T level? Are you a T2c by any chance, since it’s on both sides of the prostate. Not a T3 which is more aggressive.

You could get SBRT. It’s very commonly used and works well. It’s more likely one and done with what appears to be a lower level case. It actually is more recently the preferred method for handling cribriform. In the past, they thought surgery was better but more recent testing has shown that radiation is more effective. Some doctors still want to do surgery.

If you get surgery, make sure to get Retzius sparing surgery which can keep you continent. If you could also have the nerves spared that would make getting an erection more likely. With it on both sides of the prostate, there may be a problem. This has to be discussed with the surgeon.

After SBRT most people can still get an erection. Overtime it usually fades because they have burned the nerves.

In either case erection problems can be resolved. You can use injections to get an erection, Sometimes Cialis or Viagra will work and if not the implant is really popular 90% like it.

It will take a few months to be acclimated after surgery. You may have incontinence issues for a few weeks. You may not be able to get an erection right away.

I think I would probably prefer radiation if I were in your exact situation. If ED Problems eventually come, you can always resolve them.

@solar4ever Unless it is extended out of prostate, do talk to all the focal doctor experts which by the way they can take out most or just about all of the prostate if need be. You can do many options, not just the standard two offered even in small cities in US. You can go for Brachy, Tulsa, Cryo, etc. These are all good options. All those other things people talk about with lots of verbiage are often used to push people to the standard two option, so unless there are really reasons, call around and get as many as possible appointments. Best advice is do it fast as it takes time to get in, you can always delay your procedure if need be, they can do those RP's anytime and anywhere in US. Many times you will have to travel to get the other options, well worth it. Don't bother just with some big name medical center, some big names offer standard two options that are offered in small cities, so don't just go for a big name, go where they are experts in more than two options. However, Mayo is a big name and they have it all, many options available though you have to get to the doctors with the other options so look up doc and ask for ones that do other things. I had Tulsa, and Cryo.