Radiation vs Surgery Gleason 3+4=7, Long Term Side Effects (Cyclist)

I have been diagnosed with prostrate cancer and am told Im a good canidate for either surgery or radiation treatment....Im finding it very difficult to decide which to do. Comments here are very informative and helpful.

I went from an initial diagnosis of 3+4=7 on my first biopsy to 4+5=9 final pathology 17 months later when my prostate was removed. I am 56 and my PSA is undetectable 9 months post RARP. I chose RARP after meeting surgeon and radiologist due to my relatively young age and ability to keep radiation 'in back pocket' should it recur. I was told both have almost equal long-term success rates, but having the 1-2 punch was the deciding factor for me. The 2 big side effects as I'm sure you know are continence and ED. On continence, I still wear one light pad in the daytime due to the occasional stress-related squirt (an unexpected sneeze, running (which I try to do 3x/week, etc.). I wear a heavier pad to play golf and I don't wear one at night. I used to wear nothing but boxers but now find that the supportive underwear further helps reduce leaks. Going commando in swim trunks will find the occasional unwanted stream down my leg. I don't consider myself to be fully 'continent' by my definition because of these minor, livable but annoying occurrences. I find myself using Dude Wipes daily as these small leaks smell bad on the pad by the end of a day and I am conscientious about hoping nobody else can smell it. You lose 2 of the 3 things that help you hold it with surgery - internal sphincter and the prostate gland. So your external sphincter is all that stands between you and a squirt or worse. I should do more kegels, and maybe that would help, but I think from conversations with other survivors that this is pretty much the 'new normal.' For the ED, I'm not back to pre-surgery firmness by any stretch but I also needed pills pre surgery for erections. I used a vacuum pump a lot in the early days as I was afraid of shrinkage. Now I hate the sound of it and may use in once or twice a week just to keep it flexible. I believe sex with a ring around the base after pumping it up would work. I've also experimented with Trimix with pretty good success. Dry orgasms are a real thing and I have been able to accomplish them many times with partial or nearly full (with Trimix) erections. Emotionally, I have run the gamut. This sucks, why me, etc., but now I am feeling mostly grateful that my doctors detected it early and that God has given me the opportunity to watch my daughter grow up which is what I asked for from the beginning of this journey. I firmly believe surgery was the right path for me, but everyone is different. I hope this information is helpful to you in some small way. God Bless.

Also a cyclist. Had SBRT and 6 months of ADT two years ago. Prostate was sensitive for awhile so needed padded underwear in addition to padded shorts for biking. ADT side effects for me were mostly mental (bad depression), though my testosterone took an exceptionally long time to reach low normal (18 months) and I lost a bit of stamina and developed some osteoporosis.

Side effects of SBRT were tiredness and burning urination for about 1-2 months afterwards, then nothing. A few months ago developed radiation cystitis that's being controlled with meds. Had no bowel problems during or after treatment. Never had ED even while on ADT, though ADT did cause some anorgasmia that's now resolved. Am back to cycling like before, though did buy a wider seat.

I was Gleason 9 with 90% involvement and bladder neck invasion. I chose RALP because both opinions said I would probably have to do radiation and Lupron also, which I did. This is a 3 year process that I don't wish on anybody. Every situation is different but my understanding is that surgery is recommended for Gleason 7 and above especially with a higher % involvement (larger tumor) and either bladder neck invasion or para neural invasion. I wish you well!