Warning: Attempt at irreverent humor below. Apologies in advance if offensive to anyone.

To treat or not to treat; that is the question.
Or maybe "Are you feeling lucky"?

Summary: I would choose the least invasive treatment, if any. And maximize the length of time that I feel fit and healthy.

And as noted above, there are a number of questions about the history of your diagnosis that probably are relevant.

I am a "surgery guy".
At 72 with Gleason 9, I had RP at a COE and an excellent recovery post op. Very good continence and actually played golf at 6 weeks.
However, others have had less good fortune with side effects from surgery, some long lasting.

Unfortunately for me, I had immediate BCR, resulting in Salvage radiation tx of 4 mos of ADT wrapped around 2 mos of IMRT photon radiation treatment to prostate bed and lymph nodes.

Again, excellent results with first 2 PSAs post tx less than .02 undetectable.

So now at 74, I feel well and hope and pray that my "investment " in treatment pays me back with a number of years before I face a second recurrence and additional treatment decisions. My parents both lived to 95, although statistically that is not the prognosis for me.

And while I would choose surgery again, it has been a HARD year and a half.

My layman thought is that Radiation might be the least invasive tx w/ a minimal amount of immediate side effects (not a guarantee).

And I would want to avoid any ADT, as that would have an immediate and significant impact on your QOL. It messed with my mind, balance and stamina.

So I end where spino began: Quite the conundrum; both medically and personally.

Wishing you the best counsel and guidance from your physicians, and peace with your decisions .