Waiting 18 months with a 3+4 may not have been advisable. There’s a good chance of spread. You should get another biopsy and see what’s going on, more likely the cancer has spread in your prostate and your Gleason score may be higher.

You definitely should be seeing a different doctor. Active Surveillance is more for 3+3 than 3+4. Get to the Mayo Clinic ASAP.

A prostatectomy would completely replace a TURP. You might be in a situation where you get the TURP and then need a prostatectomy, so all the pain and time wasted on the TURP is totally wasted.