Welcome to the best site on the web for patient to patient interaction. This site was a blessing to me and the many members here. You have asked a lot of good questions. I'll take a crack at the answers. I am not an expert but an experienced patient, so some may agree or disagree.
First - Doing radiation + seeds + harmones is shooting the tiger all at once and hoping he dies. It is a shotgun approach since I won't really know if my cancer is out of the capsule or not, and if it will come back. If it does come back, the basic only option after all this radiation is harmone theraphy (since my insides will be too scarred for further radiation).
Taking a dam the torpedoes approach was my strategy. In this order: Surgery, Hormone Therapy, Radiation, all as adjuvant therapies and I had completed all steps in 6 months. (HT continuing). There is some promising information that this improves long term QOL and survivability. I am not as certain replacing surgery in these cases with seed implants improves anything.
Second - The theraphy described seems a little gray since the harmones will push low PSA scores, but those can be construed to make one think they are cured when all they are doing is suppressing.
HT kills prostate cancer cells. Your case appears like it will benefit from HT, but I would still consider all options before deciding to proceed with HT as a first treatment. It comes with many side effects. It will lower PSA by shrinking the tumor size not by suppressing PSA.
Third - is there a sense of some comfort after surgery in seeing the pathology report and knowing something of where you stand - ie: in relation to positive margins, and cancer spread?
Definately there is satisfaction getting the prostate pathology report. For my it left no doubt I was on the correct treatment path. Even though I have advanced disease, my PSA was able to get to an undetectable nadir. Then I fired the shotgun. With Radiation, while many say equally effective, it comes with what is called PSA bounce. This is a rising and falling PSA over time, that leaves you a bit nervous when it rises and relieved when it falls. A pendulum I chose to avoid.
Fourth - Would it be better to have the surgery to see what the pathology says - that way the possibility of radiation for salvage is still available?
Yes. Like the last answer, you will have more choices down the road, and while that does not insure better long term results, it does lend peace on mind. (Tony's Opinion)
Fifth - Is there a little peace of mind knowing you have the screwed up prostate with cancer removed versus still there?
Answer same as the last two.
Finally - It appears that surgery has far more side effects than radiation (although I have heard some tough stories on radiation also), but is there really that big a difference?
There is no doubt that surgery has more front end side effects. In the long term it evens out. And some do not tolerate RT well. Seed implant can lead to blood in urination/orgasm which can have a mental effect. You have to weigh the evidence and make a decision. Then don't look back. I've said it before that this site has the best lemonade makers on the planet. Given any situation the folks here always try to make the best of things. And you will too.
Your doctors claim to succesfully treat 90% of his patients seems a bit exagerated but he may have had that success rate by chance. The truth is that 85% of prostate cancer patients are cured and 15% are not. With my numbers, those percentages are likely reversed. Though I keep Faith, Love and Hope in my treatment arsenal. I also have a motto: Stay positive. I send that message to you as well.
Age 45 (44 when Dx)