Great to see that you are doing a lot of research to decide on your treatment plan. I was five years older than you when I was diagnosed with Gleason 7 (4+3) and had to assess my life goals and treatment options. My highest goal was life for 30+ additional years free of prostate cancer, with continence 2nd and erectile function 3rd.

I ended up deciding on a radical prostatectomy at a center of excellence, Mayo-Rochester. If you want the best possible outcome and least chance for negative side effects (incontinence, ED, infections, etc.), you must go to a center of excellence for the treatment plan you chose. In addition, it is vital to do your research on the surgeon/oncologist/etc. to ensure you have the best possible and most experienced doctor. I did not want the department head, best instructor, or the surgeon who wrote the best books. Rather, because I chose surgery, I wanted the most experienced surgeon, who had done thousands of successful robotically assisted radical prostatectomies. This surgeon was doctor Igor Frank at Mayo-Rochester. What an amazing individual and surgeon. When I first met with him, he did not push surgery but rather wanted to ensure I chose the procedure that best aligned with my situation.
As I said, I was 55 when diagnosed. Also, I was/am very fit, very active, eat healthy, and not overweight - From my research, this does make a difference in outcomes and potential negative side effects. For my situation, there were absolutely no long term side effects . Obviously, immediately after the surgery, there was some incontinence, but this subsided and was tackled over about two months - I kept a pad underneath me at night for several months, but this was more to make me feel comfortable in case unexpected incontinence occurred. Doing all of your post surgery physical therapy is crucial. I did not do professional PT, but rather did my own at home. For myself, I had no erectile disfunction at all. Unwanted night time erections with the catheter were not comfortable, but tolerable.

Good luck with your treatment decision and I pray all goes well for you.

Jim