As @heavyphil says PNI is not a big worry. I had PNI and 15 years later I’m still alive even though I have BRCA2 which prevents my system from correcting DNA errors.

I had a prostatectomy 15 years ago, But that was because my father had radiation and it didn’t work.

Both prostatectomy and radiation will eliminate your PNI problem.

You worry about “ high-grade prostatic intraepithelial neoplasia.” but it, Like your pirads 4 score, isn’t a big deal since it just means it could potentially lead to Prostate cancer. Surgery or radiation will eliminate issues related to those problems.

Yes, if you get surgery you can have radiation if it comes back. But at your age radiation may eliminate the cancer until something else kills you.

Don’t panic, Your cancer is very treatable.