The more I read on this forum, the more I am leaning towards no treatment of ANY KIND. Radical Prostatectomy is major, life altering surgery with serious life changing quality of life issues, Radiation almost as bad, and hormones and ADT, good God, destroy the man just to keep him alive. I am 70 years old my PSA went from 4.47 to 6.44 in October 2023, I had 4K score test and MRI fusion perineal biopsy at Mayo, and was diagnosed February 2nd 2024 with Gleason 4+3= 7 w/ 70% in 6 of 23 cores, 3 cores had Gleason 3+4=7 w/ 40% I had Pirads 4 pm MRI w/ 12 mm lesion ( volume .42cc) my prostate is 50.4 cc so low volume tumor, I had PSMA PET showing nothing outside the prostate, and my Decipher score was 0.38 Low Risk of Metastasis, so it showed 3.4% risk of met at 10 years and 3.4% risk of mortality at 15 years, average lifespan for men is 82 or less. Granted, that is with standard of care treatment. Risk with no treatment of any king increases your risk 100% so 6.8% big deal, I'll take those odds against ruining my life, I don't even want to have a catheter. I have done tons of research on all forms of treatment, including focal therapy, Hifu, Brachytherapy, Tulsa Pro, Cryotherapy, and they all have side effects. I have also done major research on the Ketogenic diet, intermittent fasting, and foods proven to fight prostste cancer, watched many You Tube videos with Dr. Thomas Seyfreid, Dr. William Li ( food as medecine) Dr. Ken Berry and many others. Glucose feeds the cancer cells, so eliminate all sugar of any kind, vigorous exercise reduces Glutamine which is the other cancer cell fuel, I went on this and in one month, lost 13 pounds, feel great, PSA is now down to 5.12, yes it is an extreme regiment and diet for this former carb lover, and food lover, but I'm willing to sacrifice that rather than take a chance of even 10% of lifelong ED or Incontinence and having to wear a pad or diaper, also some treatments like radiation can damage the Rectum and affect your bowels, I don't care if that's a 2% chance, I'm not taking it. At some point, quality of life is more important to me than seeing how long I can survive. Prostate Cancer is big business, billions of dollars and the medical industrial complex is geared to "TREAT", surgery, radiation, emasculating drugs, you name it, not many doctors recommend diet & exercise to fight low or mid grade cancer. The current treatments seem so primitive, they just cut out your prostate and take 2 sections of Urethra, shortening your penis 1.5 inches in addition to a good chance of impotence, sounds like a treatment from the middle ages. I watched my Dad go thru it, and even if it metastasizes after 10 years, it's not the end of the world, and very few men actually die from prostate cancer, look up the ProtecT study in the UK same survival rate at 15 years for intermediate PCa 1/3 of men RP, 1/3 of men Radiation and 1/3 no treatment just Active Surveillance. Think very hard before having any treatment, there is no rush, even the most aggressive form take a while to spread. So now I am 71 and on Active surveillance, will just check my PSA every 3-6 months, In the meantime I have had 10 great months, no symptoms of any kind, I will let nature take her course, I would like to be a case study for NO Treatment and see how it plays out, I've had a great life so far at 71, I'm more afraid of living with side effects that would, for me ruin a great life. Everyone has to make their own decisions, and I am not recommending my choice, I just know there has to be some others out there in their 70's or 80's that feel the same.