My follow-up appointment at Penn was today. They would not recommend PSMA stating the low grade present. I'll check with Sloan Kettering. Penn however will do some sort of Decipher testing (which they are doing research on right now) and will call me back with details. But as @jeffmarc said, Penn is recommending treatment because a lot of cores were positive and one of their interpretation was 3+4. They said there is a good chance I will need treatment in 2 to 5 years if I go on AS. I am meeting with a Radiation Oncologist as well as a Uro-Surgeon at Sloan Kettering. I'll see if I can have John Hopkins read the slides as I hear they have some world renowned experts. But even if John Hopkins comes back saying everything is 3+3, I am still leaning towards surgery. I was told since my prostate is still normal size, they can pull the bladder up during surgery which will greatly improve incontinence. They will also do nerve sparing surgery. I don't know! This came out of nowhere. Absolutely zero symptoms even now!