Radiation is a safe procedure which has fewer side effects for most people than surgery. Urgency to pee is not a common problem after treatment. Incontinence can be a problem after a few years, but not always.

You should speak to a radiation oncologist, and a urologist who does surgery. Maybe even multiple radiation oncologist to get different opinions.

Have you had a PSMA PET scan to see if the cancer has spread outside the prostate? Urgency to pee could be due to spread.

You have a lot of good options.

A friend of mine had HIFU a few years ago, and they didn’t get all of the cancer. He’s been struggling with rising PSA for a few years and using ADT drugs off and on to control it.

He always had an option of going back for a second treatment, but for some reason didn’t want to do it.

In 2017 I had Gleason 6 on both sides of prostate. In 2023 I had a small lesion Gleason 7 on one side and had all of the gleason 6 & 7 removed from that side. I am going in for an MRI next week. You may end up with a small hole in your prostate. Mine would fill with urine, and when I rolled over the urine would move and it felt like you were wetting the bed. The hole healed and there are no issues now. I ended up with some infection from the biopsy before the HIFU, but was cleared up with 30 days of a heavy antibiotic. Life is good now, with no loss of erections or continance. The cathetar for a week is not a fun experiance, but better than a Gleason 7 tumor growing in your prostate. I still have Gleason 6 cancer on the other side of prostate, but life is good. I am 58. If you still get erections, make sure to clean the dry blood off the end of the catheter and keep it lubricated, tough to wake up in the middle of the night with an erection trying to grow over a dry tube with dried blood on it.

Have you investigated NanoKnife or HDR Monotherapy Brachytherapy or SBRT ?