Considering that article’s conclusion (and others as well), that “… the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer.”), I knew that this would come down to personal choice. Here’s what I did —> Whenever I have a major decision to make - buy a house, a car, any choice that make impact my life, anything major, ,…..I make a list of outcomes — what I want and what I don’t want.

So, I first had to do some very serious introspection and truly understand myself and what I wanted to come out of my prostate cancer treatment.

I wanted to balance survival (of course!) with good quality-of-life, along with the possibility of treatment in the future if needed (as medical treatments progress). I wanted the least chance of ED, GU, GI, bowel or other similar complications - quality-of-life following treatment was an equal priority with success.

For me it was always about utilizing the best treatment techniques to get the best outcome while still surviving and maintaining my quality-of-life. (Every medical-related decision I ever made, I made the same way; why not this?)

I had referrals by my urologist (a surgeon) to specialists in all treatment modalities appropriate for my numbers - internal radiation, external radiation, and focal therapies, and thoroughly interviewed each of them.

So, I put together a spreadsheet and listed all treatment options from the referrals, research, and literature that I had read. Then I listed all possible & possibilities (%) of side-effects from each type of treatment, and gave each one a score (1-x). The one with the lowest total “score” ranked highest. I then took that list, and narrowed it down based on the prevention techniques available for each side-effect.

I then “scored” the quality of life priorities that came out of my personal introspection (1-x) , and compared that final score result with the multiple treatment options score result.

The score that was closest matching was my 1st choice (proton radiation), 2nd was IMRT (photon), 3rd was SBRT (photon); surgery ranked last. (Due to having two lesions, one on either side of my prostate, I was not a candidate for focal therapy.)

So at 65y, (during April-May 2021), I had 28 fractions (2.5 grays each fraction) of proton radiation + ADT (two 3/month injections of Eligard) + SpaceOAR Vue.

That was how I decided on treatment. So far - 4 years later - everything is going great.

Also, note that I was making those decisions between 2018-2020. Technology, treatments, and medicine have all advanced since then so, you may have options and considerations that weren’t available to me back then.

Ultimately, you’ll have to come up with a methodology that’s suits you, and then choose a treatment that fits your life priorities, psyche, view of life, and side/after-effects you’re willing to deal with.

Good luck!

Just wanted to add that if you have cribriform cells or IDC , you might have better result with RP. Radiation is definitely still an option and can give very good results, but cribriform cells sometimes can evade radiation and both cribriform and IDC are features that point to very aggressive cancer that tends to metastasize.
Wishing you the best of luck with whatever you choose to do .