There's a long time adage about PCa: "If you can cut it out [prostate/PCa] and put it in a jar, you've cured it". That 's long been my mantra and my anticipated choice while working in the prostate Ca field. And that seems obvious if you are highly certain your PCa is confined to the prostate. Yet, when my surprise turn came at 79 yrs, with 30 years of monitoring PSA, a rising PSA over 4 yrs to 7 ng, led to a Gleason of 4+5, but a clear PSMA PET scan forced me to review this long held idea of the choice I would make. My final decision was based on three things; Fewer side effects with radiation (although ADT is not benign due to side effects), greater confidence in ruling out metastases (PSMA PET), and significant improvements in targeting the radiation (5 days at higher dosage) and minimizing the likelihood of side effects (e.g. Hydrogel placement, etc). So, a comparison of side effects flipped my prior assumptions of my treatment choice. Note: Advances have be sufficiently rapid that I found it difficult to make decisions based on published data in the literature because my judgement was they often do not reflect these current improvements.

Good luck to you both.