At your age, a lot of people say they would prefer surgery because you can get radiation after. I had surgery at 62 and had to have radiation four years later. Didn’t stop there, I have BRCA2 so it keeps coming back. Still around 16 years later, even though I’ve had four reoccurrences. The drugs we have worked great.

When I had surgery, they did not give me ADT after Because I was only a 4+3. Gleason nine they frequently want to give you ADT for at least a year if not two. A lot of it depends on how well the surgery went.

I have a list of NCCN recommended hospitals if you give your location, I can tell you whether or not any of them are close.

Here is a link to a person that’s talking about newer techniques, and doing surgery. Techniques that give you a better chance of being continent and having an erection after it’s done. These are things you could talk to your doctor about.
https://connect.mayoclinic.org/comment/1548188/
While you have mentioned some of the advanced problems that can occur I see some missing. I wonder if anything was mentioned about them in your biopsy. intraductal, ductal, large cribriform, or ECE. (extra capsular extensions). They can make the cancer much more aggressive.