I am 57 and had a radical prostatectomy last fall (Gleason 7 - 4/3). Based on my experience, I would highly recommend a radical prostatectomy. When you chose to do the RP at a center of excellence like Mayo-Rochester, they have the latest tools/procedures (robotic assisted surgery, nerve sparing, etc.). For me, the most uncomfortable part of the surgery related to referred shoulder pain (from expansion gas) and the catheter. It took about a week for the shoulder pain to reside and my catheter was removed after a week as well. in my case, I wanted to get the cancer out of my body and did not want to rely on imperfect tools/scans to track any remaining cancer within my body (if it was localized). Fortunately, post surgery pathology indicated that the cancer did not spread. I now feel confident that I have done everything possible to rid my body of this cancer. However, I am a realist - The cancer could come back because of micro-metastasis (time will only tell).

For me, the most aggressive choice (RP) was the only logical choice - 57, healthy, life expectancy (without active cancer) hopefully 30+ years, willing to put up with potential negative side effects (impotence, incontinence) Fortunately, I have done well with side effects, but I have been aggressive in rehabilitation habits. However, everyone has to make their own decision based on personal life expectations - Life estimate, willingness to put up with side effects, etc.

Good luck with your decision and I pray all goes well with whatever path you choose.