I faced the same decision as you and Dave in 2016 and chose surgery. It is an intensely personal and emotional decision but here are some of the considerations:
I was Gleason 7 and cancer cells had probably not escaped the capsule; PSA was 12+ and was doubling every year; I was 74 and in good condition with the prospect of many years of life however, I had just watched a close friend die of prostate cancer and it was not pretty. I had to take some action. Review of the literature, especially the Harvard Annual Review of prostate cancer, confirmed that we really don't know much about prostate cancer and that the available therapies were fraught with awful side effects. The available drugs are for advanced prostate cancer and radiation is non-specific and kills all in its path; incontinence and impotence are common and the prospect for a cure much less than with surgery.
The genetic evaluation on my fresh biopsy tissue came out at 5 on a scale of 10 so was not much help (this is based on an algorithm developed by following several thousand men and looking for genes that are common in fatal and recovered cases - the data base is small and so not reliable). So that left surgery or watchful waiting. The trouble with waiting was that if it continued to grow, I would soon be too old for surgery and once it breaks out of the prostate and metastasizes the chance of a cure with existing therapies is low and surgery is no longer an option.
Surgery had a high chance of a complete cure with the downside being possible incontinence and/or a severely impaired sex life. But the alternatives were worse and so, after talking to some men who had done it, I opted for surgery. It was done at Mayo on a daVinci and turned out well. The surgeons were great! I am now 3.5 years post-op with a PSA still undetectable. The cancer seems to be cured but it won't be declared so until 5 years. Adverse effects are some very minor leakage that is easy to manage, an inguinal hernia 4 months post-op (caused by blowing you up with CO2 for the duration of the surgery so the micro instruments can get to your parts) that has been surgically fixed, some ongoing chronic urethral pain (2-3 on the 10 pain scale, can live with it) and ED. The ED is a problem with all surgery and your sex life will never be the same, but it is not bad, just different. You will have to use ED drugs or devices. But I will take that in return for a cure. One bonus is an increased urine storage capacity and a very strong stream; BPH is gone forever!!
Any time that cancer can be cured by surgery, it is a good idea to do it. I like the idea of a long life without prostate cancer.
Hope this helps.