Your description of your priorities post-treatment reminded me of my quandary in choosing the initial treatment option. I am 71, was GL 7 (4+3), with possible EPE, cribiform, PNI and .89 Decipher. Negative PMSA. I bike and/or go to the gym almost six days a week--definitely not in your category, but physically active. So it was pick your poison--incontinence and sexual dysfunction or radiation and ADT and all that entails. My feeling was with those characteristics, the odds of avoiding recurrence were not in my favor. So I chose surgery (on 9/22/25) because I would be back on the bike quickly (3 weeks, but only short/indoors to start) and back to "normal" quickly. I wanted to do all I could before any recurrence and (to me), what sounded really terrible: a month of radiation and 6 months/year of ADT. Surgery pathology was pretty good: clean margins, removed lymph nodes were negative, confirmed EPE. My first PSA was non-detect and I just returned from a great bike trip to Tucson. I do have incontinence (and likely will for a long time or forever because surgeon could not do nerve sparing surgery in my particular case), but I don't find it to be much of a problem; I just have adapted to it. So I feel good about my choice, but this and a lot of the other discussions on Mayo Connect only confirm there is no "right" answer and you have to choose what makes sense for you and what you value, after learning all you can. Good luck with whatever option you choose!