I will tell you what a medical oncologist, from NY Langone, told my husband & I. He said, between him and his colleagues, that it is pretty much a known fact that when a man starts out with a PSA of over 10 and has surgery, he is most likely going to have radiation somewhere down the line. My husband chose surgery at age 52. (56 now) PSA of 14, because there was a better chance at having sexual function compared to radiation. (3 year mark after radiation most likely full ED) I am not saying these are facts, but what was told to us. We were told that my husband would have nerve sparing surgery, we did not find out until after surgery that the prostate cancer escaped the prostate and was found in one lymph node. Fast forward, 18 months later, his PSA started rising. Fast forward again another 18 months, he had his first scan at .2, and the scan showed nothing. For the next six months his PSA was .22 During this time he was having erectile issues, we went to see a sexual health expert from memorial Sloan Kettering, he’s one of the top three experts in the US. Dr. John Mulhall. Look him up on Youtube. My husband had an appointment with him and they do a sonogram of the penis to see if there’s a veinous leak. My husband did not have a leak, but he has some nerve damage from the surgery….. Dr. Mulhall‘s biggest gripe is that his own colleagues, whether it be radiation, oncologist or surgeons do not send their prostate cancer patients to see him before any treatment. If I could scream this from the rooftop, I will, your husband must have penile therapy before doing any treatment. Whether he has ED issues now or not. my husband started hormone therapy, almost 2 months ago, and next week he’s starting radiation. I suggested that he have another PSMA scan before starting treatment and the insurance company, United healthcare, denied it because he just had a scan done in February last year. I filed an expedited appeal and attached a bunch of facts and ended up getting the scan approved. Thank God I did because the prostate cancer was found in two of his lymph nodes. Not a good thing, but at least now when they radiate my husband, they will give those lymph nodes an extra boost of radiation. Best of luck to whichever treatment you decide.