Not sure test results and recommended treatment match up

Because mine was in seminal vessel and pelvic lymph nodes: decision was made for me- RT

Neither radiation nor a prostatectomy is a guarantee that you'll get all of it, unfortunately (the two treatments have comparable overall-survival stats), but based on my layperson's understanding of your situation, I think you have good reason for optimism whichever path you choose.

Best of luck!

What I meant by "nuclear option" in my original post is RP. Not too keen on radiation and hormone treatments. I'll see how I feel after meeting with the radiation oncologist. My main concern is whether either prostatectomy or radiation is warranted based upon my MRI and Biopsy results. Would either be over treatment? I am vacillating between thinking we could actively survey this or just moving forward and getting it out. Prostate cancer is a tricky business.

I've been down a similar path. A very long story. My personal opinion is to error on the safe side. Do something, and soon, and reduce the risk of further, and perhaps deadly complications.

You should realize that the urologist is a surgeon, So operating is what he would normally do.

Good to hear your speaking with a radiation oncologist.

Do you have a very minor case that some people might say is a possibility of active surveillance if it weren’t for the PI-Rads 5, need to get more advice, and Find out what the Pet scan shows.

You don’t mention a Decipher score result. At this point, it would probably make sense to get one, It can let you know if your cancer is aggressive, more information than the Gleason score.
If it’s real low after radiation, you might not need ADT. I was on ADT for eight years the benefits outweigh the drawbacks, you can stay alive longer.

I'd be leaning toward radiation. They treat the seminal vesicles with radiation when needed. It's good you are seeing a radiologist. I'd want to look into MRI guided SBRT. Radiation will shrink benign tumors, without being targeted

".... have it out and be totally done with it. "
I hope it's that simple for you, but, it might not be. Very often, "ask me how I know", once you're in "the club" you're in. At the minimum, it'll be something you'll have to watch closely for the rest of your life.

I would really do your own research, I don't know the teams you're seeing for consults, but, often, like in my case, the specialist recommends the procedure that he/she does. So in my case, the surgeon wanted to cut, and the RO wanted to zap.

What pushed me towards the RP was the fact that IF you get a recurrence, having had the RP, it's not a great big deal to follow up with radiation (known as salvage radiation) and ADT and possibly other meds. If you get the radiation as primary treatment, then recurrence, the operation to remove becomes a lot trickier because of the damage you've done to that neighborhood of your body with the radiation.

I went that way because my brain always goes to "what's the contingency plan." Makes me more comfortable.

Having said all that ...."possible extension into the right seminal vesicle" might change things a little. As suggested in an earlier post, I might want to see what the PET scan shows you before really making a choice, it's not perfect but it's probably the most comprehensive test for this at this time.

One more thing..if you'll indulge me. I applaud your thoughtful approach to this. Critical thinking is absolutely necessary in working with your team to pick the treatment path that's best for you.

Best of luck to you going forward!

All great comments for your consideration.
Surgery and radiation have the same long term outcomes: successes AND failures; so there is no wrong choice.
Both treatments come with their own set of side effects - no getting around it. The real benefit of surgery as primary treatment is that if your cancer recurs, it can be treated with radiation. If you have radiation first, it is difficult (but not impossible) to then have surgery since the radiation makes it difficult to dissect nerves, etc. from fried tissue.
However, radiation has come SO far and hormone therapy is SO much better, that I am not reluctant to recommend it as your first option over surgery.
As has been pointed out, your Decipher score is paramount: you may not even need ADT (hormones) if your score is low.
Personally, I chose surgery at age 64 because I did want the option of radiation down the road and it did turn out to be necessary. But at age 71 or more, with TODAY’s technology at a center of excellence or equivalent cancer hospital, I would lean more toward radiation.
Surgery has side effects that are life changing for a lot of men…Best

Also, others have posted here that modern, more-precise radiation therapies like SBRT (Cyberknife) or Proton Beam don't automatically preclude a prostatectomy later the way that older, less-targeted radiation therapies did.

I don't have any personal knowledge about this, but hopefully others will jump in.

I appreciate all of the comments to my original post; all are helpful. Has anyone gone the prostatectomy route with a very small amount of 3+4=7 cancer, as in my situation? Does the volume of cancer, or lack thereof, have any bearing on the risk or potential for spread? Thanks.