Hi L777.

I'm sorry to hear about your husband's diagnosis at such a young age.

I'm not a doctor and I have no medical qualifications so bear that in mind when you read my remarks. 

About 10 years ago (when I was 56) I was diagnosed with T2 prostate cancer which was treated by a radical prostatectomy. Since then I've required no other treatment.  In the following years, I've played an active part in our local prostate cancer support group, which is now in abeyance due to Covid.

T3 prostate cancer is when the cancer has broken through the organ itself and has spread to a small local area.  It is often curable, but the treatments are necessarily more aggressive than I required. 

You asked specifically about the advantages and disadvantages of radical prostatectomy.  With a T3 cancer, your husband will almost certainly have a course of radiotherapy after surgery, and maybe other treatments such as hormone and chemotherapy.  These last two are outside my area of knowledge.

The first thing to know about a radical prostatectomy for a T3 cancer is that there is a chance of it being curative, even without the additional treatments.  Adding those treatments brings the chance of a cure up considerably.  Even when it's not cured, prostate cancer can be controlled for many years, and there are many men with "incurable" cancer who are living healthy and happy lives. 

The surgery will almost certainly be carried out by means of a robot, and in the skilled hands of an experienced surgeon, all cuts can be made with great precision.  Once the surgery is complete, all the tissue is taken to the path lab for analysis and the complete extent of the problem can be ascertained. In particular the Gleason grade, whether the lymph nodes were involved and whether the surgical margins were clear.  And within 6 weeks, the patient's PSA should drop to less than 0.1 and hopefully stays there. 

I'm not saying the radiotherapy on its own can't cure the disease, because it can. But to my mind it lacks the precision that a skilled surgeon can offer; the tissue can't be examined in the path lab, and although the PSA drops, it doesn't drop to the same low level. It is well known that PSA after radiotherapy wanders about somewhat (including the notorious PSA "bounce") so you don't get either the reassurance that all's well, or the clear indication that something is wrong. 

There are risks of side effects with every treatment.  If the surgery is carried out properly, then the risks of permanent urinary incontinence are small.  Mine cleared up after 6 months.  Unfortunately, I doubt that it will be possible to preserve any erectile function with either form of treatment - but even that isn't as bad as you might think. I think the main problem with radiotherapy is the risk of bowel problems.  I simply don't have any personal experience of RT so I can't speak about it.