Should I choose radiation or surgery after meeting with oncologist?

Bob — I am also a Gleason 4+4, Stage 1, PSA 6.7, highly localized in one core, 0.83 mm. Also like you, given 50-50 surgery vs EBRT+ADT. This was in August 2023, when I was age 74. After consulting with 8 physicians at four institutions, I went with 42x EBRT and 4 months ADT. In retrospect, I wish I’d done no treatment at all. I’d have preferred dealing with cancer rather than the nightmare I’ve lived for 2 years and 9 months. In the interim I’ve read dozens—maybe hundreds— of clinical trial results, meta-analyses, and peer-reviewed medical journal articles. I feel sure I was over diagnosed and overtreated—especially since overtreatment is reliably estimated by PCa docs themselves at nearly 50%. To this day, cancer has never cost me so much as a twinge or pinch, while cancer treatment has rendered my quality of life at zero. This was true till two months ago, when I went outside conventional medicine to concierge medicine, in order to obtain authorization for testosterone replacement (TRT), which for the first time in more than two years has provided me with a measure of recovery. On April 18 I had successful sex with my wife for the first time in a year. (Before cancer treatment we never had sex less than weekly over 52 years.) Just as important, I recovered all the muscle mass lost to cancer treatment and got my body fat down from treatment-induced 23% to my pre-treatment 13%. I was a world-ranked masters marathoner pre-treatment and, while I certainly don’t yet have nearly the stamina to achieve that again, I can look forward to possibly competing in track at 800m and 1500m. I should also add that I was surprised to learn that lots of masturbation—as much as daily—is recommended along with TRT; it not only is great for restoring penile health (size, color, firmness) but even can help prevent PCa recurrence. Despite this so-far happy ending, I still have major bowel issues, as in having to go about six times a day and with wild swings between diarrhea and constipation. Which leaves me still wishing that I’d chosen no treatment at all.