mayoclinicadvice23, THIS IS NOT ADVICE -- I believe that every instance of PCa is unique to that individual. But in response to what you were asking, I am sharing my unique experience.

I went approximately 20 years post-biopsy diagnosis without treatment. The initial diagnosis was 3+3 and surgery was recommended. A couple of years later, after a second biopsy, the diagnosis was 3+4, with treatment highly recommended. (I don't remember one or another treatment being particularly recommended.)

I went ~20 years from that first biopsy until I decided to have treatment, when my psa had reached 56, as I remember, after some 8 years without any PCa-oriented testing. (I can not tell you why I waited: I don't know, other than I was worried that each treatment I had been offered might too negatively affect *my individual lifestyle*.)

Again, I emphasize that this was *my individual experience*; in participating in many groups and attending numerous conferences, I have not encountered anyone else who has similarly avoided treatment.

To add to what you asked, as I imagine all readers will wonder, at -76 years old, a PSMA PET scan showed cancer in the prostate and (had advanced?) in some pelvic lymph nodes, and I started (only) ADT (though radiation treatment was also highly recommended), which after a problem and discontinuance with abiraterone, and several treatments with Lupon followed by 6 months of pause, the psa seems to be rising -- so far only somewhat, but perhaps significantly.

Best of luck to you (and to me and to all!) in whatever you decide!