I am IMMEDIATELY put off by his urologist not providing him with a copy of his biopsy report. I had to ask my first urologist for mine. Those who have read my posts know what I think of my first urologist, Dr. Joe Schlockmeister.
My second urologist handed me a copy of my path report, MY COPY, at my first post-op. I didn't have to ask for it. BIG difference in attitude. He had already told me when he visited me after the surgery that he didn't think I had anything to worry about. But of course, we couldn't know for sure until the pathology report was completed.
With the biopsy report in hand your friend (or you) could easily go to:
http://www.mskcc.org/applications/nomograms/Prostate/PreTreatment.aspx
enter his own numbers and get a very good idea of where he stands. Click the button at the bottom of the page for "Enter Additional Details for Medical Professionals" His biopsy report will have most of this information, leave what he doesn't have blank. When he hits Calculate you will get a snapshot of your (statistically predictive) cancer extent and prognosis.
Knowledge is power and will quiet his fears. John T has some excellent posts about methods for acquiring addditional information that will further fine tune the prognosis.
DX at such an early age often means an aggressive variant of the cancer, and this is nothing to mess around with. If he doesn't step up to the plate reasonably soon, he will be forced between choosing between a hard death; or radiation and hormone therapy, and then chemo, when the cancer becomes hormone refractory. NOT pretty pictures, especially at that age. This DOESN'T mean he should rush his decision.
My wife had a friend in nursing school who had an uncle decided to ignore his prostate cancer. He died at 55, with the cancer in his bones. A hard death, way too early.
Your friend's numbers are great, indicating early stage, and he has any number of options other than surgery. If he does choose surgery, he is at an age where he will recover much more quickly than us old farts. I had a great recovery and great outcome after surgery (at 64), many of the other posters did too. Find the right surgeon with the best stats, if that is his choice.
If he chooses the right surgeon, he will probably avoid the side effects he fears. Much of this has been gone over in detail in posts like "Head's Swiming ..." "Treatment Options . . ." and "What Would You Do Different . . ." on previous pages.
This site is an incredible resource. Your friend will survive, and if he applies himself and does the necessary due dilligence, he will make the treatment decision that is right for him. It's not easy, and the information is hard to sort out. This site will bring it all together for him. Lots of links to other treatment options. But, he will have to work at it.
One final point: I don't think that just because you go to Johns Hopkins, Sloan Kettering, MD Anderson, Cancer Centers of America, City of Hope, that you willl necessarily get the crackerjack surgeon (or other provider)you seek. You MAY get the old guy who's still doing the procedure he learned in med school twenty years ago. If he's close to where he could get a referral from a poster who had an excellent outcome, then this might be a good choice.
After he decides on his treatment option, he then has to find the best provider. Not easy. But, possiblly the most important part of overall decision.