Hi Avalance. Sorry for the delay, but Welcome to the Forum where no one likes to be! There is a long-standing thread here dedicated to the
Gleason 9 and 10 guys, like you and me.
I can't promise you anything, but a normal future is certainly a possibility. Yes, you will have to decide between different primary treatments, but I can speak for the surgery route, which I took. If you have reason to think you've been diagnosed early and that there is a good chance your PCa is prostate-confined, surgery may have some nice advantages for you to weigh.
First is your (relatively) young age -- the younger your are, usually the better the chances of a good urinary and continence outcomes. I was toying around with Viagra before my PCa diagnosis for the start of ED symptoms. After my surgery (almost 4 years ago) I still use it, but not all the time. I am about
99.9% continent, but can leak a couple of
drops if I cough suddenly and don't prepare my muscles. If I weren't lazy and did my kegel muscle exercises, I could probably get to 99.99%
Surgery has an advantage over RT for high/very-high risk men: you wait until the surgery is over and you have both your path report and your first PSA to learn whether any further treatment is needed some months after your heal; if not, you play the PSA waiting game like every single guy after treatment. I may or may not need further treatment in the future. But I'm doing great now. Does the fact that my shortened urethra tugs my penis back a tiny bit back bother me -- no. The length of the penis itself really doesn't change, and studies say with time most men "recover" most of their erected length. I'm glad I'm alive to use the inches I have. Good oncological outcomes of prostatectomy are strongly correlated with one's PCa being prostate-confined and not Gleason score. The catch is that prostate-confinement can only be suggested by one's diagnostic workup, especially imaging. The definitive yes or no is had only after the procedure.
Other Forum Brothers can explain their decision for the radiation route. It involves an upfront commitment to radiation (often a combination of two kinds) together with a course of ADT for a non-trivial duration.
Yes, the decision may be a difficult one, but that's because we do have a decision between two routes with roughly the same chances of success. Would you really prefer to be in a situation where you were told there was just one treatment route?
Can you tell us the details of your biopsy, your PSA history, and any other salient details? We welcome you among us and we'll do all we can to help you!
Djin