I offer this not to be boasting, but to share the conversation I had with two surgeons @ age 74 when biopsy showed the same as you (4+3, etc) 2 years ago. "Normally I would't suggest surgery, but in your case..." and then they ticked off all the reasons they thought my system might tolerate it: normal BMI of 22, no problems with heart, lungs, liver, kidneys, diabetes, blood pressure, neuro degenerative disease; no prescription meds, fitness equal to someone 20 years younger (exemplified by completing my 30th Ironman in Hawaii 6 months prior). I did have surgery, used no narcotics after leaving the hospital after 24 hours, return of full bladder function after 3 months, full sexual function after 7, and PSA < 0.02 over the subsequent 2 years. So, yes surgery *can* be an option for those of us in our mid-70s, but it *always* carries risks. My own decision was influenced by my father's death from prostate cancer 8 years after radiation treatment @ age 72, who was in similar outstanding health...no meds, daily vigorous activity, no medical problems. He lived in a remote location before the advances of both surgery and anesthesia over the past 30+ years, so that drove his choice.

There's no universal right answer. But I would be leery of surgery had I not been so physically healthy. Even then, I knew the risks. So far, it was a good bet...so far.