Deciding on Radition vs RP - conflicting opinions

I have biopsy showing Gleason 3+4 with 40-65% involvement in 3 samples. My PSA is 5.3. I'm 75 yo good health. BUT I have obstruction and use catheters to urinate 4 x day. Both Oncologists and Surgeons say I need to do a TURP before Radiation. My Surgeon says Radical Prostatectomy is recommended. Spoke with two oncologists: 1 says I should do hybrid brachy (2 weeks) then IBRT 8 weeks. Must wait 2 months after TURP. the other oncologist says I need genomic testing. If my Gleason 3+4 is "favorable" then TURP followed by 5 weeks of IBRT might be the right program. Brachy could be overkill. He says his Varian TrueBeam will control movement and precisely apply the radiation. My rectum will be shielded by a spacer. But he needs the genomic scoring first to know for sure.

My concern about RP is incontinence after surgery. Urine retention prior to cathing has probably weaken my bladder. RP may lead to long term leakage. Maybe the TURP plus IBRT is the optimal solution. My surgeon says I can go that route, but RP would not be option later, certainly not in my 80s.

Has anyone else been in this situation? I have told my surgeon (whos has done 2600 Robotic De Vinci operations) that I want to hold off on surgery until I get genomic test results and a urodynamic test of my bladder. Can anyone share their experiences with this situation?

I think surgery would fix both problems without the risk of irradiating the newly cut tissue. That can cause incontinence too.

With your "favorable intermediate risk" PC, you really don't need brachy boost therapy. I agree that that's overkill and you'd be asking for urinary problems.

/pcnrv.blogspot.com/2017/05/brachy-boost-therapy-should-be-reserved.html