I was reading through responses so far and there are very good points and ideas, so I will just provide my thoughts on the basic question and my experience.

I would vote for removal. I was diagnosed on the younger side (48y) and fortunately had access to excellent resources within a reasonable distance at Johns Hopkins. They offered a multidisciplinary panel that would review your medical file, scans etc. and then you would meet with the panel later in the day to review options. The late, great Dr. Partin was part of this and ended up being my surgeon. I chose the RP mainly for piece of mind, in retrospect easier treatment plan vs. radiation, but most importantly to leave open the radiation option for down the road. My father had Prostate cancer as well and due to his age, decided on radiation therapy initially and when it returned, his only real option was Lupron. He succumbed to prostate cancer.

I was diagnosed as 4+3=7 in the Dominant Nodule and 3+3=6 in a Secondary Nodule. Margins were negative. My PSA was 3.7 that had increased over 300% in less than a year. I realized there were going to be ED and other issues, but still felt getting that bugger out of me was the best course of action. I had the usual leaking for a few months (wore pads), initial issues with ED that improved over time especially with the use of Cialus, then eventually good on its own. I was able to get back to somewhat normal life, the libido and ED continued to improve and celebrated each anniversary of being cancer free. That was 8y and 3m, up until yesterday. I met with a Radiation Oncologist since my PSA was no longer undetectable. It was hovering around .34 for a while and then doubled to .7 in best we could tell a 2y period. Missed PSA's in between so please stay vigilant! Course of action now is MRI Prostate, PMSA and Decipher. Starting 6m treatment on Orgovyx and 7.5 weeks of radiation therapy.

But this doesn't change my mind that the RP was the way to go back in 2016. The availability of the Decipher test is very useful it appears. Best of luck on your journey!