Glo, that Decipher IS concerning, and echoes the finding of cribriform cells, which are very aggressive.
I posted 2 links yesterday to questions about IDC (intraductal cells/cribriform go hand in hand) on the forum. One said that successful treatment usually involves surgery followed by radiation (25-39 sessions) with ADT.
I know that some would prefer to do surgery and then monitor PSA to see where it goes. That might work in a less aggressive case but IMO (not an oncologist, but a patient who ultimately needed SRT anyway with much lower risk factors) I would hit this hard and not give it a chance to spread.
Of course, surgical pathology will be the true indicator of the severity of his disease, along with lymph node examination. Just be aware that surgeons can sometimes be cocky, claiming ‘we got it all’ and no need to worry about next steps; Sloan is probably more of a collaborative effort, with one department conferring with another - but I would still seek an RO’s opinion after the surgery to see if they recommend further treatment.
RO’s see all the surgical ‘failures’ and know which factors were probably responsible for the cancer returning. Best,
Phil