My father-in-law, age 65, was recently diagnosed with prostate cancer (T3b N0 M0). Some evidence of extracapsular and seminal vesicle spread, no evidence of bone or lymph involvement (via CT and bone scan). Biopsy should 12 of 12 cores positive, Gleason scores of 8 and 7 (4+3) for most samples.
We're trying to decide between surgery and combination therapy (hormones/radiation), and the evidence in either direction isn't definitive. The combination therapy approach suggested is Cassodex + Lupron followed by HDR temporary brachytherapy followed by IMRT for 5 weeks.
Any thoughts on the consideration set of tradeoffs? We're told that continence and sexual function tend to be better preserved via radiation, although hormone therapy does drop levels to castrate.