Significant disagreement between 1st and 2nd opinions, what to do?

I was really having a hard time with the side effects and after 18 months using Lupron my PSA was undetectable so I discontinued it. Now after 18 months w/o my PSA is .01, which was expected. Urologist has set a threshold of 2 before we reconsider treatment.
My Gleason score was 8, stage 1, and I would have preferred surgery but I was having some severe blood pressure problems and the surgeon flat out told me I'd die on the table. That left me with the only option of hormone treatment and 20 sessions of radiation. Hope this helps.

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.

Please don’t think that surgery is a definitive treatment for PCa! Doesn’t matter which TopDoc expert does the procedure; surgery has a 30-35% failure rate ((recurrence after surgery) and has a significant impact on your quality of life - impotence, incontinence, etc.
No treatment is without failures -none of them. All in all, if your cancer is confined to the gland (cannot guarantee this either), an excellent treatment is 5 sessions of SBRT using MRI guided technology: it has documented less marginal tissue damage, leading to better quality of life. Proton therapy is also excellent, but I am not aware of any head to head comparisons of it with MRI guided photon therapy but others on the forum may know of them.
Your overall strategy of being cautious before diving into anything is excellent, but this is a slippery adversary and there are NO guarantees of cure with any of the current treatment modalities.

While I am fully aware that radical prostatectomy is not guaranteed to cure my cancer, hearing that 30-35% percent of RP patients experience a recurrence does surprise me a bit, if that is indeed what you meant. Does surgery equate to RP, or is it a broader category? And am I correct in assuming these percentages include all RP's, regardless of whether or not cancer had spread beyond the gland?

I'm sure I am guilty of some level of rosy thinking about my own case, but I'd be curious if people disagree with my perception that RP has the best chance of being a one-and-done treatment for a cancer that has not moved beyond the prostate? Probably too many variables to say with any certainty (and again, there is the unpleasant issue of continuing follow-up biopsies with focal therapies).

I'll just say it...radiation really scares me. I can't help thinking that a precisely wielded scalpel
will be more likely to remove all that is needed without going beyond what is needed than some poisonous, semi-predictable, particle-emitting chernobyl-seed being plunked down into a cozy warm bed of fragile soft-tissue. However, I need to learn, so I will take your advice and read about real people's experience with the treatments you mention. Thank you, Phil.

While I am fully aware that radical prostatectomy is not guaranteed to cure my cancer, hearing that 30-35% percent of RP patients experience a recurrence does surprise me a bit, if that is indeed what you meant. Does surgery equate to RP, or is it a broader category? And am I correct in assuming these percentages include all RP's, regardless of whether or not cancer had spread beyond the gland?

I'm sure I am guilty of some level of rosy thinking about my own case, but I'd be curious if people disagree with my perception that RP has the best chance of being a one-and-done treatment for a cancer that has not moved beyond the prostate? Probably too many variables to say with any certainty (and again, there is the unpleasant issue of continuing follow-up biopsies with focal therapies).

I'll just say it...radiation really scares me. I can't help thinking that a precisely wielded scalpel
will be more likely to remove all that is needed without going beyond what is needed than some poisonous, semi-predictable, particle-emitting chernobyl-seed being plunked down into a cozy warm bed of fragile soft-tissue. However, I need to learn, so I will take your advice and read about real people's experience with the treatments you mention. Thank you, Phil.