Mine is a similar case although my PSA was 8.8. My first inclination was “cut it out” and I scheduled a robotic prostatectomy. After settling down I started researching and have decided on SBRT 5 sessions. Most of what I’ve read makes me skeptical that surgery is ever a very good option unless you’re in a small percentage of people who won’t tolerate radiation. Much of what I have read indicates that despite a clean PSMA PET, higher Gleasons often have microscopic cancer in the margins or pelvic lymph nodes. That means they may need to add radiation after prostatectomy and you get double treatment (triple if ADT) and potentially double quality of life side effects. I will do 5 proton sbrt treatments over 2 weeks which I believe will hit small margins, seminal vesicles and pelvic lymph nodes. There are some tests out there to help guide your treatment plan. Prostox assay can see whether short or long term radiation is best based on your individual genetics. Also Artera AI to see if ADT is even going to be beneficial in your unique situation. Also important to take into account your own comfort level from a psychological perspective. Will you feel more more confident with one type of treatment over another. I have found many YouTube videos from very reliable sources that have helped inform my decision from UCLA, MSKCC, MD Anderson and others. Prostate Cancer Research Institute has been a very good source of education as well. Best for any choice you make. Solidarity!