Trying to decide treatment options and quality of life after

A very large percentage of doctors advise RP or radiation because they don't know anything else. There are other treatments, Tulsa pro for example which was greatly improved on mid 2023 and is now a very good option. If I can do Tulsa so can you, you just have to take the local docs opinions and move on to a doctor that will give you more than the standard two options which should be your last choices unless things are spread or metastatic or outside prostate in any way. Options should be stay on AS as long as one can, then Tulsa Pro (maybe hifu in a few cases, and maybe a new one called vanquish), then as last resorts are RP or radiation. Just since Tulsa Pro is in a new form since 2023 not many places have it, so most likely you have to travel somewhere, that is not that big a deal.
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Tulsa
https://tulsaprocedure.com/find-a-tulsa-pro-center/
https://tulsaprocedure.com/
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Here is my post on Tulsa Pro - search on here many others are having it, and mine was not a 3+3 or something, I had one needle 4+4.
https://connect.mayoclinic.org/discussion/tulsa-pro-initial-experience/

Without the PSMA PET, you really don't have enough information to make a decision yet. Metastatic vs nonmetastatic makes all the difference in the world. Enjoy today. You'll have plenty of time to worry later.

It is very hard to give a suggestion about what to do when there is no information supplied, Besides age.

What was your PSA at diagnosis? What was your Gleason score after the biopsy? Was anything else found in the biopsy like intraductal, cribriform, Seminole vesicle invasion or ECE. All of those things make it more likely for your cancer to come back. If you didn’t get a full biopsy report, ask your urologist for it So you can get the answers.

Considering your age, proton radiation might make sense for you. It has much less likely chance of Causing other cancers as you get older.

You need much more information in making that decision.
But generally speaking, success rates comparing surgery with radiation are statistically equivalent no matter what treatment chosen (https://www.nejm.org/doi/full/10.1056/NEJMoa2214122).
It mostly comes down to side-effects and quality-of-life to find what’s best for you.. (For me, proton beam radiation + Eligard was the right call.)

Although, to be frank, the risk of causing secondary cancers is very low with modern radiation therapies anyway, so you'd be looking at maybe a reduction from 2% extra risk to 1.5% extra risk (those are just example numbers, but in the approximate range).

Quality of life is IMHO a great thing to consider. As most of these smart compassionate individuals here in this forum are; most will tell you that they are not doctors. I wish that many of the doctors that I have seen were as compassionate and understanding as these folks here. I think that most doctors know what they know and unfortunately for us they aren’t as current with the advancements in PC as they could be.
Given the well known reality that as HB’s ( Human Beings ) we often respond differently to the medications that we take. I also think that we would like to believe that someone who’s been dealing with PC for a long time can tell us the best thing to do but magic bullets exist in movies more than real life.
My Dad and his two brothers all had PC my dad eventually did Lupron treatments. He was detected at 70yo Dad lived 22 years and he never had radiation or surgery. His youngest brother opted for seed implantation when it was first offered. His docs told him about THE HOPE of this new treatment but warned him that if it didn’t work that there was no backtracking; no surgery for removing the prostate after it was determined that the seeds were not working. Dad’s middle brother decided to do nothing and went so far as to tell his doctor he didn’t want anymore testing and didn’t want his doctor to mention it again.
The seed implantation failed bro 3. He didn’t take well to the news and lived the rest of his life in REGRET: crying and lamenting which affected his whole family. He passed away first at 72 or thereabouts. Number two bro developed a strange condition called dysplasia and was told he would need to eat through a tube that went directly into his stomach. After a month of pouring liquids into the tube. He decided that his quality of life was so disrupted that he told the family he decided to stop eating which of course ended his life. He was 86yo. No one ever knew how his PC was advancing and he proudly told me before he passed that he still awoke often with an erection! He was very proud of that fact.
So the three brothers died in reverse order.
Thinking about asking them what to do about PC wouldn't have yielded good advice.
My advice would be as several members suggested: read all you can about the advancements being made with prostate disease.
Best of luck to you!

I chose five sessions of SBRT radiation and six months of ADT. Radiation caused few problems--a couple months of difficult and burning urination treated with Flowmax and I couldn't ride my bike for about six months because it was painful.

I also agreed to six months of ADT which was not pleasant and caused me a lot of mental problems and some physical issues. It's now almost a year later but my testosterone has only partially recovered to about half of what it was before and is now below normal. I've developed some hip and pelvic pain but it's more of an annoyance than anything agonizing. My PSA is .04 which is really good for still having a prostate.

I've been seeing a sexual health doctor and it's been totally worth it. Between low-dose daily Viagra, some unusual penis exercises, and some pelvic floor PT, my sexual function and libido are as strong as ever, and orgasms are getting better. I now ejaculate a totally clear fluid instead of semen but it still feels good.

Here is a Stanford study, which shows the likelihood of developing a cancer is extremely small.

Stanford Edu
In
In a study of about 145,000 men with prostate cancer, the team found that the rate of developing a later cancer is 0.5% higher for those who received radiation treatment than for those who did not. Among men who received radiation, 3% developed another cancer, while among those who were treated without radiation, 2.5% developed another cancer.
Here is a link to the full study from Stanford
Prostate radiation only slightly increases the risk of developing another cancer, Stanford researchers find
https://med.stanford.edu/news/all-news/2022/070/prostate-radiation-slightly-increases-the-risk-of-developing-ano.html

Thanks. I remembered my oncologist telling me 1 or 2%, so that's even better.

0.5% would easily fall into the margin of error even for a big study, so for practical purposes, we can just say there's no elevated risk of developing additional cancers from modern, 21st century radiation treatments.

I do not know what to make out of those studies, to be honest .
According to this study https://www.nih.gov/news-events/nih-research-matters/radiation-ct-scans-cancer-risks
simple and single CT scan alone increases a risk of developing cancer. About 5% of new cancer cases can be attributed to use of a CT scan.
"Using the UCSF registry data on individual CT exams and RadRAT, the team estimated that CT use in 2023 could result in almost 103,000 future cancers. If current practices continue, CT scan use might eventually account for about 5% of all new cancer diagnoses in the U.S. per year."