I'm a 4+3, one lesion, localized as well, but older, near 70. I was initially very interested in Tulsa Pro but doctors at both Mayo and Moffitt didn't recommend any targeted therapy due to the intermediate, unfavorable risk profile. Regarding Tulsa Pro, they also cited the fairly high rate of recurrence and the need for close, long term testing including biopsies. I haven't made a final decision yet but at the moment, MRI-Guided SBRT is at the top of my list. Personally, (and I'm not an oncologist) but given your multiple MRI-visible lesions on both sides and your age, I'd be really hesitant to do anything less than whole gland treatment. In regards to SEs, if you haven't already, take a look at the just completed Mirage Clinical Trial.
https://pubmed.ncbi.nlm.nih.gov/36633877/