Hello and welcome to the forum. You’ve joined a club that no one wants to join, but there are a bunch of great people here who are all willing to help.
I’m on my second boat of prostate cancer, so I’m just sharing my opinion and not medical advice.

From what I’ve read outcomes are similar for intermediate risk prostate cancer patients receiving surgery or radiation. Since you’ve been diagnosed with unfavorable intermediate risk PCA, I would assume that your doctor will also prescribe at least a short term of ADT; Probably six months but perhaps as much as a year.

One thing worthy of consideration is understanding what your options would be in the event that your primary treatment fails. This is a big deal.

If you have a prostatectomy as primary therapy and PCa returns, you can receive radiation to the affected area as salvage treatment. If however, you have radiation as primary therapy and prostate cancer returns, with rare exception you can’t have debulking surgery to remove the prostate. Your next step might have to be chemotherapy or some form of immunotherapy. In other words, your options are more limited because surgery is typically off the table.

I opted for LDR brachytherapy as primary treatment in 2020 and PCa returned with a vengeance in 2023 with Gleason 9 Stage 3 locally metastatic. I was told that I couldn’t receive more radiation to the treated area where tumors reappeared. I could only receive radiation to untreated areas. My gene mutation doesn’t respond to chemotherapy so my outlook was not good. Luckily I found a surgeon that was willing to do salvage prostatectomy to debulk the tumor, remove one of the diseased pelvic lymph nodes and give me a fighting chance for salvage radiation combined with long term first and second generation ADT.

If I had to do it all over again, I would’ve opted for surgery as primary therapy and dealt with the short term incontinence and ED issues.

There are other factors you may have to consider depending on your age and overall health.

Good luck on your journey and don’t hesitate to ask more questions. We’re here for you.