Well, others have provided their experiences.

With the clinical data you present, the decision not to treat is not an option.

So, treat, with what?

Surgery is an option though waiting for the PSMA scan may make that decision mute if the scan shows PCa outside the prostate. In fact, much in making your treatment decision may be a function of the PSMA PET scan, is it "localized" or "advanced...!? Keep in mind there are no absolutes with micro-metastatic PCa.

Hormone therapy is an option, question, which one, for how long, do you add an ARI, again, which one?

Radiation, again, an option, again, which one and do you treat the prostate only, extend to the pelvic lymph nodes.

Then there are combination therapies - look up doublet therapy for De Novo PCa say an ADT + ARI, ADT + radiation....how long on ADT, 6 months, 12, 18, 24, 36...? Here's one link, https://dailynews.ascopubs.org/do/would-you-use-doublet-therapy-and-not-triplet-therapy-patient-newly-diagnosed-mhspc, you can find others.

Consider not only your urologist but radiologist and oncologist, when deciding on treatment.

Familiarize yourself with the NCCN Guidelines - https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459, they can serve as a starting point in your discussions with your medical team about treatment choices, keep in mind while based on science, they are population based and lag somewhat behind clinical trials impacting clinical practice. The art of medicine is the application of science to your specific clinical data,

Attached is my clinical history. I elected surgery in 2014, keep in mind the state of the imaging and treatment choices then - there were no PSMA PET CTs and treatment was binary, surgery or brachytherapy. today, you have a plethora of choices. In 2023 when my PCa came back yet again, no surprise, my medical team and I had great discussions about which treatment, for how long....

I can't say I did anything special before my surgery, my wife picked up some Depends. When my nurse pulled out the catheter, zero incontinence, didn't need them. Keep in mind statistics, Bell Curve, standard deviations, averages, mean, mode...in my 11 year journey I often fall outside any of those statistics though I am high risk - GS 8, GG4, PSADT and PSAV, 18 months to BCR...Despite my "successful" surgery, I had a 30% of recurrence, yes, it did. After surgery, well, the first weekend I travelled from Kansas City to Saint Louis to watch the Jayhawks in the opening round of the NCAAs, by week two I was playing basketball and lifting weights again, albeit moderately, no incontinence. Yes, I had a good surgeon but I also had and continue to have an active lifestyle so that helps.

So, read up, talk with your medical team, come back and talk with us after you've had your PSMA scan and consults and we'll provide our thoughts.

Kevin