Without knowing or posting his stats, it would be hard for anyone here to even make a guess. What is his gleason score, his current PSA, and previous PSA's to see what the velocity was, did they determine from a biopsy any staging? All this makes a big difference in even beginning to know what treatment direction to seek.
Your friend needs to come to terms with his diagnosis for starters. If he would really rather die than to deal with potential side affects of Ed and/or incontinence, that is pretty extreme. But we don't know his age either, if he's 85 years old, he might have a good point.
Sounds like he's in the anger mode, quite normal for many at first, but that anger won't help him with what lies ahead. Glad he has a good friend like you to help him through this and perhaps even be his advocate.
The side effects from surgery, if that was the treatment path, varies so much, you can tell that from reading on this site. He might have little problem with either, or a lot, or somewhere in between. My wife and I went through the same process, and she would rather me be alive with her and our children and grandchildren then to be dead because I was worried more about
ED or incontinene. PC is nothing to fool around with, it is a dangerous animal with a mind of its own.
I wish you two only the best, as you seek treatment methods. Since you listed no stats, its even possible he may not have to do anything for a while or even a few years.
Please keep us posted, and thanks for joining us here.
David in SC
56, 56 at DX, PSA
7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes
First PSA Post Surgery 2/9 .05, 6 month on 5/9