6 in 1 half dozen the other anymore. There is endless selection of 20" truck tires on the market and comparable sizes really arent much if any more expensive.
That's now a myth. Just checked Toyo AT's comparable 18/20" common truck size 285-60-20 and 285-75-18. The 20s were $14 more per tire.
If towing heavy, the same diameter tire, 20's will actually ride just a bit more stable with less sidewall flex.
Bottom line it's down to almost 100% personal preference and the price/performance apples to apples is almost identical.
With a greater sidewall height, though, 18s will typically have a higher load rating for the same diameter.