The level of cancer you have can often make the decision. I went with HDR brachytherapy because if delivered a high degree of radioactivity directly to the site for a short period of time (5-15 minutes). It is a two-visit outpatient procedure. I did not choose the seeds (LDR brachy) because they can move around. I did not choose surgery because of the increased risk of incontinence and ED and the initial downtime. The downside of HDR brachy is that it can cause your prostate to swell a bit and reduce your stream. Both brachy and surgery are the current gold standards. There are some beam options that offer very high success rates (the low 90's, just like surgery and brachy options). The new beam options, such as CyberKnife, apparently only exposes healthy tissue to radiation on the way "in". I'm 70, in good health, and was classed as "unfavorable intermediate". Gleason 3+4. I've been told that the "no surgery after radiation" rule is no longer a thing. I had my brachy in April 2023, so no long-term results. The best advice is to choose your doctor carefully. I had my work done at Mayo Rochester. An amazing place where EVERYONE does their job. You can contact your local Mayo clinic (and probably many others) and have a video chat with a surgeon and a radiology oncologist. There are other great clinics out there. Good luck.