Surgery or Radiation?

I will be frank about this: the ONLY reason to have surgery (which I had for G4+3 unfavorable) is if your type of cancer has a higher degree of recurrence - that’s it! If it does, you can have salvage radiation (which I just completed) to try yo kill it again.
The factors you should concern yourself with are: presence of cribriform/IDC, high Gleason score - intermediate unfavorable or aggressive (8-10), and a high Decipher Score - which is an ABSOLUTE MUST before you can make a decision. If it is considered low you are in a good place. You don’t mention having this crucial test.
Other than those factors I can think of no reason why a 73 yr old man should subject himself to life altering surgery. Robotic surgery is NOT as precise and exact as it is claimed to be - better than open surgery but still PLENTY of side effects.
You have 20% cancer in your cores - that’s nothing compared to mine - like 90%!
SBRT/Cyberknife/MRIdian are all 5 treatment events that are probably better than surgery at this point since those head-to-head comparisons are very old. Proton/photon not such a game changer in outcomes IMO but proton supposedly has less SE’s so if you can get proton, why not?
It’s always your decision but you must educate yourself, sift thru this forum using the search button for specific questions you may have. I am giving you MY input based on my own experience and that of others on this board. I don’t speak for everyone but I think many members will nod in the affirmative when they read this post. Best,
Phil

@brianjarvis Thanks! I clicked the link to NEJMoa2214122 and read through the webpage. After which I saw the posting by @jeffmarc suggesting to watch a PCRI video. In the video, the speaker also referenced the NEJM article. Yours and Jeff's postings are both helpful.
(https://www.nejm.org/doi/full/10.1056/NEJMoa2214122)

I didn’t even think twice . Remove it and move on . Kicking the can down the road was not my option . I had surgery 8 months ago . It is not for the faint of heart but dam glad I did it .

Link to the PCRI video. https://www.youtube.com/watch?v=MllXn7mnhV8

That’s what’s great about having a number of equally successful treatment options - “remove it and move on” gets the statistically equivalent success rate as getting it radiated.
According to Dr. Kwon (Mayo Clinic), the locations of recurrence occur at different rates. See Dr. Kwon’s presentation about recurrence at: https://youtu.be/Q2joD360_pI

Well, over 30% of all surgical cases do move on….to salvage radiation.
And yes, radiation can equally fail.
That is why AGE and other diagnostic factors such as Gleason, Decipher, PSMA and tumor load are all important in making a decision.
‘When in doubt, cut it out” rarely works for many cancers all the time.
Phil

At 70, I opted for HDR Brachytherapy. This is a same-day outpatient procedure. No pain, no real limitations afterwards. No bike riding, no sliding down a banister for a while, but I was out walking 1.5 miles the next day. Modern radiation techniques do much better at reducing damage to other body parts. HDR hits the cancer directly and is a more physical approach to reducing radiation exposure to healthy tissue but there are "non-invasive" procedures that promise that too (Cyber knife, etc.). Don't bother with the Decipher test, as some have suggested. Mine was pretty low, but my cancer suddenly increased anyway and was pushing to get out of the prostate. My view is that it can give you false hope. The biggest concern with radiation (though now greatly mitigated) is that, in 20 years, maybe the radiation will cause you some problems. But, when you are 108, they will likely have developed some new solutions for those problems (you see what I did there). HDR brachy sounds like a nasty procedure, but you are asleep when all the nastiness happens. The biggest pain for me was that they didn't want me to drive home (and I like to drive). But it was also nice to have my family "take care" of me. For me, the risks of ED, shrinkage, and diapers with surgery was just not I wanted to spend the rest of my life.

I am 78 years old. I decided on surgery even though the tumor board recommended radiation. I met with the radiologist as suggested by my urologist and decided the surgery offered more options should I need additional treatment. I was at the edge of being offered surgery but like you was in good health. I had a Gleason score of 7-8. Per scan and MRI both seemed to indicate the cancer was localized and that was confirmed by the surgery. The cancer was within the prostate. Just had my 6 month check up and the PSA was undetectable. The surgery itself was uneventful so to speak but the incontinence that follows is hard to live with. I go Tuesday to have the urologist take a look at my bladder. Not looking forward to that..

Surgery at 78 would seem to indicate that you are a very fit individual which is an obvious positive in your favor. I had surgery done 14 years ago at age 59. Initial incontinence required pull-up Depends, but they did the job and were surprisingly unnoticeable and not uncomfortable. My doctor really pushed me hard on the Kegels, so I intensively and continuously/constantly upped doing that and got noticeable results after several long weeks. I then went to only a pad, kept up the Kegels, and didn’t even need a pad about a month or so after that. I was also able to totally stop the Kegels with no backsliding. I continued like that for about 13 years, but for the past several months have had random, unpredictable, small leakage episodes to the point that I am back on a pad just to be safe. I don’t have the same discipline required for the Kegels that I once did, but will try to amp them up again and see what happens. If things don’t improve, it’s minor enough that I can live with it. If it gets a lot worse, I believe surgery should help. But, like you, I would prefer to avoid that if possible. You might want to really give the Kegels a heavy dose of effort, if you can, before going another route. Best wishes for your continued recovery!!

Look up Dr Grim i think his name was. He compiled graphs of cure rates comparing the major treatment paths (surgery/radiation, etc) versus your risk staging.
He passed on but theres a foundation that maintains and continues his work.
There are real advantages of going one way or the other despite the industry mantra being… the outcome of surgery or radiation is about the same… Can’t count how many times i heard this false and ridiculous statement.
Think its prostatecancerfree dot org?