Ed, I am in the same boat as you, diagnosed two years ago, Gleason 7, confined to prostate per MRI. (former) urologist recommended prostate removal or radiation. I began researching minimally invasive treatments and really liked HIFU. I also have an enlarged prostate so that makes HIFU a little problematic so now I am looking into laser therapy, specifically the new ECHO LASER 4. Nothing set up as of yet. BTW, here is an interesting study that concludes that an enlarged prostate can be protective against cancer growing and/or spreading: https://www.pnas.org/doi/full/10.1073/pnas.1815735116

Ed: Choices are individual, and I wish you well with yours.
I favor treatment. My MRI suggested cancer contained within prostate capsule. But it is not a "hard" capsule, and after prostatectomy Aug 2022 at age 72, which I hoped might be curative, cancer cells were found outside (EPE) and .19 PSA.
Today I should finish 37 radiation therapy txs. Also midway through 4 mos ADT Orgovyx.
It seems that everyone's cancer progresses, and if that is true, treating sooner rather than later makes sense to me.
My recovery from surgery went very well. Others have successfully completed ADT (hormone deprivation therapy) together with radiation.
Side effects have been significant for some men, and not for others.
Best guidance and treatment are from experienced surgeon's and oncologists, and may include seeking a center of excellence for diagnosis and/or treatment.
And you make the choices that you are most comfortable with making, including active surveillance.
Many suggest Dr Walsh's book Surviving Prostate Cancer and PCF.org free patient guide.
Best wishes for success.

Ed; You haven't given us your age and that is an important consideration when deciding what to do. I am not aware of there being any pain until your cancer has spread beyond your prostate and has metastasized. I asked my urologist the same question and he said you will be fine for the first 3 or 4 years but once it spreads and gets into your bones and other organs your pain will be unbearable.
I had surgery in 2018 at age 76 when my Gleason score was 3+4. I wanted my urologist to leave no margins so I suffered from ED and I also suffer with incontinence but I can live with that. Post surgery I was able to lead an active life; golf, ski, squash. Although my PSA was undetectable after surgery; it slowly began to rise and reached .370 in January 2022. I opted for salvage radiation in June 2022, which included two injections of Zoladex. I had no significant side effects from the ADT other than feeling extremely tired, but that has improved over time. Post radiation my first two PSA tests have been undetectable but it will be another 6 months before the effect of the ADT wears off. In the meantime, life carries on. I enjoyed 34 days of skiing, I am back playing squash (although not particularly well) and I am looking forward to golfing.
The choice is yours but make sure that you do your research. Consider joining a Support Group. They can be invaluable.

Hello Ed, your situation is exactly the same as mine. I was diagnosed with Gleason Score 7 (4/3) in the Fall, 2022. I did significant research for two months to ensure I would make the best decision for my situation (healthy, active, no other medical issues). I decided to go with a radical prostatectomy because the cancer was localized to the prostate. The surgeon and his medical team at Mayo-Rochester were amazing (minimally invasive robotic assisted). In the end, they took the prostate, seminal vesicles, and 7 lymph nodes. The final biopsy was good, negative margins and no cancer in the lymph nodes. There is still a chance for the cancer to come back, but I feel so much better knowing that the cancerous prostate has been taken out of my body.
I agree with other comments, every situation is unique and each person needs to make their treatment decisions based on their individual expectations for life going forward. For myself, I am living with the ED side effects, but have done well regaining continence. Compared to living with metastasized prostate cancer, I see the trade-offs as minimal. My uncle died of metastasized prostate cancer and the pain was significant for years. Looking in from the outside, this lay person would recommend addressing your prostate cancer while it is still localized. My opinion - A few weeks of pain from surgery are significantly better than pain for the rest of your life.

Take care and best of luck with your decision.

Jim