Good morning. Sorry to hear about the equivocal Prostate MRI results but remember that you have not been diagnosed with cancer at this time.

My 2 cents both as a patient who had an RP and as a retired physician.

Surgery (RP) by an experienced, highly skilled Urologist has a low complication rate. The upside is the cancer has been immediately removed and the pathologist can evaluate the tissue and give an exact diagnosis of the extent and type/aggressiveness of the cancer. The surgeon can "look around" and see if there appears to be any local spread during surgery. The downside is dry orgasm (but your ejaculate will diminish with radiation/brachytherapy as well), the short recovery time from surgery, the small but definable potential complications from surgery and possible incontinence. From studies, the vast majority of young men regain total continence. In the event you have local recurrence down the road you still have the potential option of curative radiation to the pelvis.

Radiation involves multiple weeks of daily short treatments. Cure rate is similar to RP. The PSA is a little more difficult to follow because it slowly goes down and doesn't become undetectable like surgery. There are potential short and long term complications with radiation, although with newer machines and protocols they are less than in years past. If you have a future recurrence, surgery is difficult sue to radiation induced scarring.

Brachytherapy is similar to radiation option but obviously doesn't involve weeks of treatments since seeds are implanted at one sitting.

All good options. Take your time. The important point is to go to a highly skilled professional no matter the choice.