I faced a similar decision last year at age 50. PSA 6.68, 3+4 in 6/12 cores, negative PSMA, 0.56 decipher. I really wanted SBRT and took a genetic test (can't remember the name) that showed I wasn't predisposed to adverse effects from short- or long-course radiation treatments. However, two local Radiation Oncologists recommended against SBRT/CyberKnife because they thought it would exacerbate my existing urinary issues - frequency (up multiple times per night), weak stream, and dribbling but no obvious blockage shown in a cystoscopy. I went to MD Anderson for a third opinion - hoping they could do MRI-guided short-course radiation - but their team recommended surgery only and would not even do long-course radiation due to concerns with my existing urinary issues and long-term side effects from radiation. The long-term effects may be less of a concern for you at 65 but have you asked specifically about radiation worsening your existing urinary issues? That was not something I'd really even considered when initially weighing my options.

I ended up have surgery at the Cleveland Clinic in June and have been pleased with the results in terms of speedy recovery, including immediate continence.