I think with T3a and one or two lymph nodes involved, you will have to accept that some cancer will be left behind by surgery, nerve sparing or not. The RT will be required to sweep up what is left.
I will try and give you an analogy. Think of the nerve bundles as the wooden branches of a tree, and think of the leaves as cancer cells. So this tree is a bit weird, as I'm saying it is completely healthy if it has no leaves, you will have to bare with me on this one. If the surgeon spots leaves on this tree he will have to cut it down, OK you might be lucky there may only be leaves on one side, so you will have partial nerve sparing.
Now think of RT as the Mother of All Hurricanes. It is going to blow through that tree and strip out all the leaves, you may lose a few small branches as well. If you are unlucky one or two leaves may survive and if that is the case then you still have cancer.
Now I think you have no choice than to have RT whether you have surgery or not. So that hurricane is going to be blowing through that tree, and it has a high chance of stripping all the leaves. Sure the surgeon can definitely chop the whole tree down, but he may leave some leaves elsewhere so you need that hurricane whatever.
Not a perfect analogy but I hope you get the picture.
Now I would argue that if you are having RT anyway, forget the surgery. RT alone may do the job. Alternatively I can see a strong argument for saying well let's get rid of as much cancer as possible because the prostate is pointless if you don't want children and if you remove that pointless gland and all the cancer in it you only have to worry about the cancer which has escaped. The problem is the damage done in pulling the prostate out, and if the RT has a good chance of killing all the cancer why take the risk.
Though I am happy for everyone on this forum, unless someone is ten or fifteen years post treatment take their success story with a pinch of salt, that includes me I am only one year post HT. Anyone with my diagnosis has a 98% chance of surving prostate cancer for five years anyway. Rather than celebrate my prostate cancer survival I should be celebrating not having a road traffic accident as I was more likely to die from that than PC in the three years since diagnosis.
You're right some urologists are a bit miserable, but I think I would be if that was my job.
Yes, I live just outside Glossop, I had treatment at Christie's. I probably remember the names of the miserable urologists but we won't discuss them here. Do you live near by? I am not averse to having a chat over a pint of beer.
Hi gaz, just spotted your post as I was typing, thanks for the vote of confidence, and for acknowledging, we can only talk about success of treatment to date. We don't know the future, but if your an optimist like me no reason to think anything will change.