It does sound a bit aggressive, IMO. A Decipher score of .51 is not terrible and just 2 cores of 3+3 is pretty much active surveillance.
But non invasive approaches, such as TulsaPro mentioned by @datatech or HIFU are better ways of dealing with your cancer at this point.
Remember , NO treatment is definitive for PCa - it can always come back no matter what. So take it slowly, keep your powder dry and let your treatment unfold step-wise, least invasive option first.
Your urologist will argue because he probably only does surgery, so you may need to seek help elsewhere.
Remember, you can always do surgery later. Best,
Phil

I got the same from the first urologist I saw with the same “if you don’t have surgery now you may not be able to have it later” he of course is a surgeon. Nothing positive about any other options. Radiation was mentioned in passing but wasn’t discussed except to say that he would not recommend it. His office called an hour later to set up the surgery. That’s when I decided there was time for a second opinion.

The results of your biopsy do not confirm what your doctor wants to do. You were working with a urologist it sounds like. Urologist do surgery, That is their answer to prostate cancer.

Someone with a Gleason six, and only two cores out of 10, would normally be put on active surveillance, not surgery. Yes, the decipher score shows you have a medium chance of something happening, But you could be on active surveillance for years before something actually happens. There’s been a lot of meetings lately where doctors discuss being over treated when someone has a Gleason six.

You should get a second opinion from a center of excellence or a Genito urinary oncologist, The ones that specialize in prostate cancer. Yes, at age 56 surgery may be a better option, but active surveillance may be an even better option for you.

Here is a video with Dr. Laurence Klotz, one of the experts on active surveillance. He can give you answers as to why you would or would not be a good candidate for active surveillance.

Hmmm, OK. Well, I think that most URO's like to do DRE's and RP's. It seems to be in their nature. I had every offer of radiation, seeding, removal, and Active Surveillance. When you say your Gleason is 3+3(6) and a Decipher of 51 percent...that sounds a little off to me. Do you mean the Decipher was .51 percent. You need to get a physical copy of your Decipher report from the URO and look at it and tell us what the Genomic Risk is and what the 5,10,15 year risks are. What is your PSA?

Now, first it sounds like you had a trans-rectal biopsy which has a difficult time getting all the prostate sampled. A transperineal biopsy could sample the entire prostate from 18 to 30 cores and then you really would know what you have and where. You did not mention if you have any tumors and the size, that will take a MRI and frankly, IMO, a MRI should have been done prior to a biopsy.

If you have two cores positive, no tumors, Genomic Low Risk, you could probably do Active Surveillance for a number of years. However, if you do that, then you need to test PSA every 6 months and MRI every 9 to 12 months. Don't let doctors lull you into yearly PSA and MRI every two years. The problem with AS is that at some unknown time, the cancer can jump start itself and spread. Something you absolutely do not want.

You likely have more options than you know, and, if you can give the members here more information they can better help you. If you had only one small tumor you could do NanoKnife, a transperinal approach that leaves the sexual and urinary function virtually untouched. There is HIFU, a trans-rectal approach, there is TULSA, a trans-urethreal approach. But, until you have an MRI with contrast you are at a disadvantage deciding what is the best approach. And honestly, if you can find a doctor that does a transperineal biopsy, I would get one of those. They are painless afterwards, almost zero chance of infection, and you get a full sampling of the prostate.