It is so complicated, isn't it?! If Jim chooses radiation, he favors HDR brachy, either as mono-therapy or adding 4 months of ADT to the HDR brachy. His radiation oncologist prefers this dual therapy instead of EMRT + brachy, saying the addition of ADT is preferable because it covers the entire body. There are so many varying recommendations, it seems.

Jim would, of course, like to decrease post-treatment side effects (knowing the incontinence post-surgery and the many side effects of ADT). But most important is to choose a treatment that is most likely to eliminate a cancer recurrence and need for further therapy.

Bottom line, we think we're back to choosing prostatectomy, primarily because it will alert us to any recurrence as soon as possible. (Worrywart that I am, not knowing if recurrence might be happening since the PSA interpretation isn't as black and white regarding cancer status post-radiation will be stressful!) It seems that the sooner we know of recurrence, the sooner it can be addressed, with our health providers' guidance. We also like the fact that after surgery, the entire prostate will be biopsied, so we better understand the degree of seriousness of cancer at that time. And, as we understand it, after initial treatment with prostatectomy, more options remain for treating a possible recurrence than if radiation is done initially.

I wish we felt more confident in our understanding so as to feel confident we're makeing a best choice. It's just hard to know if our rationales for leaning toward RP are right-thinking. You seem to be very knowledgeable, russ777! IF you have any other points of further clarification or thoughts that may make things more clear to us, I would welcome hearing back from you. Thanks a lot for what you have shared! (I'm pretty sure I understand most of what you've said!) 😉 All the best to you!