Whether a 75-year-old man should undergo a radical prostatectomy depends entirely on his individual baseline health, physical vitality, life expectancy, and the specific Gleason score or aggressiveness of the prostate cancer. If a patient is exceptionally healthy with a life expectancy exceeding 10 years and has high-risk localized disease, surgery may still be considered, though active surveillance or radiation therapy are frequently favored to preserve quality of life.