Thanks so much to you all for your helpful responses. I appreciate you taking the time to think about my situation! I will admit to being naive about much that is available to PCa patients these days.

I did purchase the latest edition of Dr. Walsh’s book and spent some time reading the chapter on focal therapies. My main takeaway was that these treatments, relatively speaking, are still in their infancy, or maybe toddlerhood. More specifically, long term studies have not yet proven them to be reliably curative. My current thinking is that if I am going to risk my continence (by far my number 1 concern today), among other things, I would like to maximize my chances of being done after one form of treatment. Additionally, the need for continued biopsies after treatment is a big deterrent for me. For those of you reading this and thinking, “hey pal, biopsies are a walk in the park compared to the things I have been through”, I get that. I do consider myself extremely lucky that my cancer was caught early and that my risk is comparatively low.

My lack of enthusiasm for radiation really stems from the same place. If I need to treat my cancer, I want to do it once. My perception is that removing my entire prostate through robotic surgery, by a skilled and experienced surgeon, is my best bet for completely eliminating the cancer with the lowest risk to my existing lifestyle. Might this perception change if I seek more opinions and learn more about other options? Undoubtedly, it might. On the other hand, my current situation allows me the luxury of saying there is more to life than cancer and I don’t want to become obsessed, or burden my loved ones with that obsession. Besides, I’m already obsessed with pickleball, I have no time for another obsession. We all have our interests and hobbies, but learning everything there is to know about prostate cancer treatment doesn’t really stimulate me. I can see how that might seem odd.

Here is what my 2nd opinion doctor said that most resonated with me:

Nowadays, nearly everyone who starts with Gleason scores similar to mine, are either eventually cured, or never need treatment. Any treatment you undergo now carries with it risks to your current quality of life. Everything about your current scores suggest a non-aggressive form of cancer. It can change, but even if it does it is unlikely to occur rapidly, and should be caught in plenty of time with 6 month PSA monitoring and biennial biopsies. If you get 2, or 5 or 8 or 10 more years without having to risk your current lifestyle, that might be worth it. Not everyone wants to live with a cancer that can be cured now, but some are okay with it.