I got radiation (SBRT), fell in the unlucky small percentage with long-term side-effects, and *still* have no regrets.

Surgery wasn't an option for me regardless with a distant metastasis, but for stage-4 prostate cancer traditionally they either would give no radiation or just a low "palliative" dose to the prostate itself. I opted for a large "curative" dose of 60 gy (which was just emerging as new standard of care in 2021), nearly the maximum allowed, and while it did cause some collateral damage to my lower bladder and rectum, it may also have helped bring me many more years of life, so I can cope with a bit of mild burning and urgency (which I've learned to manage).

In fact, every time I feel the mild burning, I tell myself "That means the radiation spread beyond the prostate and took care of any local cancer there as well". If a few still-undetectable cancer cells were starting to creep into my bladder or colon, the radiation likely sterilised them.