@lojewski 1) Risk on AS usually related to how fast PSA increases. Was PSA over 3 for several years before it went over 4? If yes, then AS is reasonable. Primary benefit is no side effects. At your age and disease, it is almost certain to progress to the point that treatment is required. As mentioned in another post it is easy to miss the point where ADT is not required. Probably easier if RP was planned treatment since you would be okay as long as contained in the prostate. Almost all genes such as BRCA are not on Y so risk is 50% if your father's cancer was gene related and those genes double the risk from 1 in 8 to 1 in 4.
2) Focal therapy has the highest probability of leaving sexual function as is. RP eliminates ejaculation even with complete nerve sparing (90%+ of fluid is from prostate) and RT usually cooks the prostate enough to do the same (about 75% chance). If getting a focal therapy, make sure it is done by an expert. Did you get consult for both HIFU (anal) and Tulsa-Pro (urethra) delivery?
3) Radiation side effects have gone down with modern equipment with better aim. The MR Linac is the best such that quite a few centers in USA will not use it for prostate cancer (other cancers have more exacting requirements). It is the way to go if deciding on RT. Your RO can tell you how much radiation will hit rectum, bladder, etc. based on the plan. With that machine it will be very close to plan. I had no long term side effects from radiation (CT adjustments at beginning, but not active in treatment like MRI) except going dry. Had a little urgency right after treatment. No bowel symptoms. No ED but sex and orgasm different than before treatment not in a good way. A few have posted different & better; most different and worse. One reason AS and Focal are tried even with the risks they have.
4) As has been mentioned RALP-RS (posterior) and RALP-SP (anterior) do not cut the ligament and have much better continence results than the standard RALP procedures. However, you will need to find an expert surgeon in using the technique chosen to get excellent results. Wheel1 (posted response) had RALP-RS.

@lojewski
I Finished my 5 SBRT Mridian treatments in February 2023. The Mridian is comparable to the Elekta unity. What they can see in real time, they can treat. I had 3+4 Gleason, 10.2 PSA and a low Decipher. I did have spaceoar. I feel incredibly lucky and blessed that my situation has worked out the way that it has with my treatment.

I have had Little or no real issues. My urination is normal as are my bowel movements. I am in no pain. My erections are not as hard as they used to be. I get tested every three or four months for my PSA.

For me, I would never have considered active surveillance. No doctor will ever guarantee to you that it won’t grow at a specific rate, or grow at all. They are educated guesses. I wanted it treated and to move on. If I had to make that decision again, I would do it the same way, except maybe adjustments in the biopsy.

@lojewski
You have too many positive cores with 3+4 to consider active surveillance. I know people with 3+3 that waited to be treated and ended up 4+5. Once cancer starts, it doesn’t usually become milder. It becomes more aggressive unless it’s treated..

You had a lot of of cores with cancer. You don’t show us your T score. Were you a T2b? That would mean it’s on both sides of your prostate so focal therapy doesn’t make a lot of sense. SBRT radiation does.