The perineural invasion is not your worry - it’s fairly common. It’s the high grade epithelium/ high Decipher Score risk that’s a concern.
Your age and overall health are VERY important in making your decision.
At 74, with some co-morbidities like brittle diabetes, hard to control HBP or advanced heart disease, radiation would be the better option.
However, if you are a fit and trim 74 with no other major health issues (uncontrolled by meds), surgery is a good choice because your type of cancer could return - no matter the initial treatment - and you could then do radiation/ADT to attempt a cure.
I just advised a friend NOT to have surgery at age 75 since his cancer is low grade, low Decipher and he has a lot of medical issues. Best,
Phil