Newly diagnosed

You need to find out what your pirads score was on your adenocarcinomas that were found. You need to have an MRI done to get that answer, not sure how you got that information.

That will also tell you, whether or not this could be aggressive and should be treated sooner

Don't know if Vanderbilt is doing it, but I went with Tulsa Pro at Mayo. My PSA went from 8.6 to 0.68. My cancer was also anterior. Medicare & supplement ins. covered the cost. My story:
https://connect.mayoclinic.org/discussion/tulsa-pro-experience-mayo-clinic-mn-july-2024/

The recommendation for the booklet is absolutely correct. Learn more about this disease which will enable you to ask the right questions.

I was diagnosed with a very similar metric of Gleason score 3+3, several areas of the prostate cancerous by localized and PSA 6.47. I went to Loma Linda for proton radiation therapy. I was treated for over 2.5 months every morning at about 0730. The prep procedure has changed but the process has not. This was in 2010. I suggest you focus on proton radiation therapy as to where, who and the cost. it is expensive. I have TriCare for Like, so it cost me nothing except housing and such. Proton radiation was initially "invented" to treat children with brain cancer. Then became the focus on prostate cancer, too. Good luck/RH

Take your time before making a decision. My Gleason Score was 6 for 7 years. Mine just went up (3+4) and had SBRT radiation instead of surgery. 5 sessions every other day for a week and a half. Talk with a radiation oncologist before making a decision.

Talk with your care team but Gleason 6 is often managed with "Active Surveillance". Imaging and decipher as @jeffmarc mentioned will guide treatment decisions.

(All said above by others)

Thank you all so much for the support.
Here is my thought process.
I have been reading several Pubmed papers, used perplexity.ai, Read about 105 pages on Dr. Walsh's book yesterday.

**FACTORS**
1. PSA went up from 1.2 in 2016, 1.86 in 2017 to 4.3 in 2024
2. Free PSA 6.9% (Sept 2024) (not a good number according to Dr. Walsh's book)
3. PSA density: 0.19 (statistical threshold limit is 0.15)
4. mpMRI found three lesions: Right anterior TZ in the apex to mid gland (1.4cm), Left posterior medial PZ in the base (0.4cm), Left posterior lateral PZ, mid gland (0.8cm)
5. 26 cores were taken in Biopsy.
6. Adenocarcinoma found in Right anterior medial (2 out of 2 cores: 50% and 30%)
7. Adenocarcinoma found in Left Anterior Medial (1 out of 2 cores: 30%)
8. Adenocarcinoma found in (ROI)-Right Anterior Apex-mid TZ (2 out of 3 cores: 60% of total tissue: Don't know why this does not say the % in each sample)
9. HGPIN in Right Base (statistically 25%-36% chance of developing cancer later)
10. HGPIN in Left Posterior Lateral (statistically 25%-36% chance of developing cancer later)
11. Atypical (ASAP) in Left Base (statistically 30% to 40% chances to be diagnosed 3+4=7 later on repeat biopsy)
12. My Report says Gleason score 3+3=6 (Grade 1)

**My Inference**
1. If Lesion in Right anterior was 1.5cm or more, it would be PIRAD 5
2. Percentage of adenocarcinoma in 5 out of 26 cores is 19.2%
3. PSA level jumped 109% from 2017 to 2023
4. Appears to me that my case is sitting on the upper limit of what is typically considered for active surveillance due to the volume of adenocarcinoma and PSA density.

**Question**
1. Is this still reasonable to watch and wait?
2. Is it okay to ask a surgeon if he does or has done a lot of surgeries using bladder neck preservation and nerver sparing techniques?

It seems to me as a layman that you would just be watching and waiting for things to get worse.
And as far as bladder neck preservation goes, ALL surgeons do this - the only thing that would prevent it is deep invasion of cancerous cells into that area. So I wouldn’t focus too closely on this one aspect. JMHO

Doesn't look like any reason to rush. When I was first diagnosed at 3+3, I consulted with 4 urologists. All said just to watch it. Recommend you seek additional opinions.

Did you watch that video?

It discussed the over treatment of people with 3+3.

Why don’t you do the testing we recommended and see what it shows. Don’t panic until you have more information. Decipher and PSMA pet Will tell you a lot. A PSE test will tell you whether or not there is cancer in your body, Since 3+3 doesn’t always indicate cancer.

Yes, many RO’s And urologist will treat you with a 3+3.

Just want to throw in a couple thoughts to add to all the other's great tips.

First of all, you've got this! You've come to the right place for help and early. My PCa journey began much as yours did but later in life. After many years of monitoring my PSA as it rattled around above the 4.0 mark, I finally had a biopsy which culminated in surgery 7 months ago. I have no regrets but my decision only applies to me, and your decision is yours. I would have loved to have had Active Surveillance but for me it wasn't the right choice. I'll put the link below to an earlier posting with more details about my case.

Take a deep breath, relax, don't get the cart ahead of the horse. You've caught this early.
During my journey, I found myself overwhelmed at times. Being an engineer, I was constantly thinking about the data and worst case scenerios. And contingency plans. I called it "analysis paralysis"!

One breakthrough, for me, was when I found that one of my fellow retirees had a long history with prostate cancer including surgery. His support was incredibly comforting. I wouldn't have had that support if I hadn't decided to tell family and friends what I was going through. He came forward. His experience supplemented the great tips I learned here. So I encourage you, if you haven't already to try to find personal contacts or support groups.

I have a practical tip regarding the Dr Walsh book, which I absolutely recommend. Get the Kindle version as well as the hard copy. The reason is vocabulary. We've all been hit with a new lexicon. When I would find a new word that I knew I had seen somewhere in the Dr Walsh book, I could search quickly using the Kindle app. Remember that Dr Walsh didn't write the whole book. It is written by contributing experts by topic/chapter. Their varied view and comments on a specific topic vary and can be quickly seen with Kindle.
Finally, regarding your question "Is it okay to ask a surgeon if he does or has done a lot of surgeries using bladder neck preservation and nerver sparing techniques?"
I concur with the others, that bladder neck preservation and nerve sparing is standard procedure. It is my understanding that, normally the surgeon will already know before planning surgery based on imaging and biopsy. Another, more important question, I believe is to "ask a surgeon if he has done a lot of Robotic Assisted Radical Prostatectomies (RARP)? I was surprised that "a lot" is at least a thousand! My surgeon had done over 3500 but my regular urologist had done only 100.
Hope this is helpful and best wishes for you on your journey.
https://connect.mayoclinic.org/discussion/76-too-old-for-surgery/?pg=2#comment-1075893