I had a similar decision:
> 65y
> PSA 7.976
> Gleason: 3+4=7
> localized

With success rates comparing surgery with radiation being statistically equivalent, the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer.

> “eliminating the cancer” by getting the prostrate removed is not a certainty, as you see from many of the comments on this forum.

> “Radiation is appealing but I do fear the long-term effects.” Whatever those “long-term” effects are can be minimized (or avoided). What specific long-term effects concern you most?

For me, I’m very process-driven with every major decision that I make; this was a major decision. So, I first had to do some serious introspection and truly understand myself and what I wanted to come out of treatment.

I wanted to balance survival (of course!) with 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 a priority.

For me it was always about utilizing modern 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?)

So, I put together a spreadsheet and listed all treatment options from the referrals and literature that I had read. Then I listed all possible & possibilities (%) of side-effects from all types of treatment, and gave each one a score. 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 introspection, and compared that final score result with the treatment options score result.

The score that was closest matching was my 1st choice (proton), 2nd was IMRT, 3rd was SBRT; surgery ranked last. So at 65y, I had 28 fractions of proton radiation + SpaceOAR.

That was how I decided on treatment. So far - 4-1/2 years later - everything has turned out great!

Good luck with your decision.