Radical prostatectomy vs external Beam and Seeds for Inter. risk PC

Is that 2 identified spots on MRI?
How many cores were positive in your 4+3?

"For me the critical factor in deciding between surgery and radiation was the higher incidence of bowel dysfunction following radiation. The rate is fairly low and has decreased as techniques have improved, but it is still significantly higher with radiation than with surgery."

Bowel issues are exceedingly rare now SpaceOAR is being used. Incontinence is a much bigger issue that primarily affects those who choose surgery.

1% for bowel issues vs 18% for incontinence.
Equally unpleasant issues to deal with but the importance of an understanding of math should not be underestimated.

2 areas on MRI
Confirmed with needle biopsy. 17 samples, 2 positive,
One 4+3, the other 3+4.
Decipher, intermediate unfavorable. Recomendation for adding ADT.
Did have spaceoar.
PSMA Pet further confirmed findings.
Bowel issues. Irritation. Frequent urges to defecate
No incontinence.

I disagree with most of what you said in your reply, and I fail to understand the snide implication that my original remarks are the result of a poor understanding of math. Where we do agree is that bowel dysfunction is uncommon following radiation and has "decreased as techniques have improved". In fact, I said just that in my original post. Where we do not agree is on the numbers. I do not know the source of your 1% figure, but it is not consistent with several articles, like this one from Johns Hopkins:
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/bowel-dysfunction-after-prostate-cancer-treatment
Of course, any of these statistics fail to assess the specific risk for a specific patient. That is why I had several discussions with the doctors at Johns Hopkins, where I was treated, to understand the likely issues for my particular circumstances.

I would also take issue with your subjective assessment that bowel dysfunction and urinary incontinence are "equally unpleasant issues." I do not feel that way, and I suspect many others would agree with me.

As others have mentioned, your decision is personal and should align with your individual life expectations. Last year, I was in approximately the same situation as you - Gleason 7 (4, 3), 12 of 19 cores cancerous, cancer contained to prostate (confirmed by RP), 56 years old, healthy, active... I investigated all the treatment options and decided to go with a radical prostatectomy. For me, this aligned best with my life expectations, wanting 30 years of cancer free active life. A RP is the most aggressive procedure, but removes all the known cancer from your body. For myself, this was important. I was unwilling to take the chance of relying on imperfect imaging devices to direct/place radiation/seeds/etc... I also wanted the follow-up pathology that could physically confirm where the cancer was actually located. My surgeon removed nine lymph nodes and fortunately these were clear as well.

As you probably have seen, most everyone will say they are happy with the procedure they chose and would choose the same path. I am in that camp, extremely happy with RP procedure and outcome. However, that is my my situation - You will need to take all our personal opinions (including the surgeons and radiologists) into account and make a decision that aligns with your life expectations.

Good luck and I am sure you will choose what is right for your life going forward (please please go to a center of excellence and choose a doctor that is the best you can find, lots of experience).

Age 74 with 2 cores 4-3 and 2 of 3-4 out of 30 cores from my 120 gram prostate. PSA 2.9 PSMA Pet scan said all confined to the area of the 7mm lesion on one side where the MRI Fusion Guided Transperinal Biopsy was done. I was at Mayo Phoenix and had the 5 treatment proton radiation with almost no side effects at all and it has been 121 days since my last radiation treatment. My urine flow even feels like it is a little better. The only side effects were about 5 days after the last treatment I had a very slight pinkish discharge before my morning bowel movement for three days. I did have the SpaceOar Gel inserted. The biggest side effect was after the 2nd radiation treatment session. After the first treatment I had my insulated mug of coffee waiting for me in the car and I drank it on the drive home and finished the pot when I got there. I did the same thing after the 2nd session even though they warn you to avoid caffeine. About an hour after I finished the pot my bladder said, "you dummy you should have listened". I had to pee about every 15 minutes weather I had anything to pee or not. Needless to say, I avoided coffee for about two weeks after my last session. My 3 month PSA check was UNDECTECTABLE! Good luck with your decision but I am thrilled with mine.

Thank you, it is going to be tough for me to do without coffee as well, the only vice I have left!

Terribly sorry if I offended you and can assure you that was not my intention. The 1% figure I was referring to was of Grade 2 or greater rectal toxicity. With the most advanced centers, this figure holds true I think. Maybe it is 2% and this may be a Japanese study I am referencing.

There was a study that I read recently (can't remember of course) but patient reported and the clear winner in terms of post treatment distress was urinary incontinence. A cursory look here on this board and there are almost no folks complaining about rectal concerns post radiation while urinary problems post surgery are pretty common.

I think that on message boards like this one (and in doctors offices BTW), surgery is often presented while wearing the most rosiest of glasses. I think I was simply trying to alert readers to the fact that while rectal/bowel issues can present after and during treatment, they can hardly be described as common.

I am guessing here but 5 years ago, a majority of readers would have heard primarily from surgery people on this forum. Slowly. radiation is getting a place on the soap box. I think it is well deserved and one that the numbers support (that was my general point with the math comment) in my opinion.

I wish you the very best with your recovery.