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.

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