Two of the smartest people I know had to face this decision. One is a Princeton PhD in Physics and the other is a Harvard Med MD/PhD in anesthesia. Both were very well connected in the medical world and did extensive research.
Both chose the old fashion, nerve-sparing open surgery route.
The reason was that the prostate was removed whole, not cut up in pieces as with minimally invasive or robotic surgery. This allowed the pathologist to fully examine the ex-planted prostate and determine how far along the cancer was (staging) and how/if/where it had spread.
Both have full sexual function and urinary control.
My father-in-law was a Princeton/Harvard Med/Hopkins surgeon and he chose the radioactive seed route. The seeds turned his prostate into a clump of scar tissue, but it stopped the cancer. He died at 87. However, he lost sexual function and urinary control at 80, so his last seven years were spent miserably in diapers. He really regretted the radioactive seed decision.
In my research, I’ve discovered that minimally-invasive robotic surgery does remove and preserve the prostate whole.
Yeah, that is why I said no radiation. The same thing happened to my dad. The radiation treatment cost him over a decade of life because when he passed he was otherwise in excellent health.