I was diagnosed with Gleason 3+4 PCa in 2007. The two options that were recommended to me were robotic assisted radical prostatectomy or radiation. The surgeon that I consulted did not leave me with a feeling of confidence, and I also consulted with a radiation oncologist who recommended IMRT. I went back to my urologist for a final consult and I took the less intrusive option, IMRT.
Fast forward to 2013 and the cancer is back at a 4+5. I was treated by a brilliant surgeon at MD Anderson, who performed a salvage prostatectomy. It first seemed curative, but over the next couple of years, that turned out not to be the case. I've been on Lupron off and on for 4 cycles, and it's now castration resistant. The medical oncologist and I will decide on the next course of action next week. It will either be to see what a standard therapy does, or to enter a trial tailored to PCa.
In retrospect, if I could have predicted the future, I would clearly have gone for the surgery. Or I had the option to go to MDA for proton therapy, but the radiologist said there was no clinical benefit of protons over IMRT. Hindsight is 20/20 as they say. Knowing all of this, I'd be hard pressed to recommend radiation as a first-line treatment. Just IMHO; I'm not a doctor.