Over-treatment is indeed an issue, because the side effects--possible impotence and/or incontinence--are nasty. I also think that radical removal is overdone. It is also an appropriate choice only if the cancer has not spread beyond the prostate capsule. Seeding or some other form of radiation that can treat the seminal vesicles and just outside the prostate is more thorough. The side effects may also be less than with radical surgery.
It is important to know the PSA level, Gleason score, and size of the tumor. Based on those, a treatment or non-treatment decision can be made. For example, if the PSA is only 3, the Gleason is 5, and only a couple of samples show cancer, waiting is a viable option. I have a friend whose PSA was 80 and Gleason was 8 (the max is 10). He had the full kitchen sink treatment as part of a clinical trial. I was is a much lower risk group, but my father had died of prostate cancer at 68 after surgery at 66. So I decided on brachytherapy. My doc has a nearly 100% survival rate after 15 years--and a survival rate of 100% for guys with my numbers. It's been nearly 9 years and things are fine so far.
My ejaculation is not "dry," but the volume has been reduced by over 90%, because my prostate, which normally would manufacture the bulk of the semen, is scar tissue, not normal prostate cells. The other side effect relates to urgency of urination. Previously, when I felt a strong urge to pee, I could defer it by up to an hour. Now, it's about 15-20 minutes. My erectile quality is good to very good, though there has been a slow, gradual long-term decline over 50 years, irrespective of the cancer. Sometimes, I think that getting old is a bitch, but it sure beats dying young
