Responses to all of your comments/questions —> Your questions are right on target. You should continue to follow the numbers and let those numbers (and others) guide your decision-making.

It’s not that you received conflicting information. It’s that with prostate cancer there is no one right answer. There are many treatments that can successfully treat your condition. What you’ll find it comes down to is that the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer. So, a 3rd, 4th, 5th,….opinion doesn’t really provide any value.

> prostate cancer usually has no symptoms so, your situation of “…. have no symptoms of anything….” is quite normal.

> you mentioned having been seeing your urologist for 4 years; what was your PSA last year? Even though “he hadn’t said anything…”, what did you say about each of your previous four years of PSA results when you saw them?

Other numbers to consider in addition to your PSA of 9.3 ng/dL? (If your PSA reaches 10, something else is going on that another test may identify.)

> what is your PSA Doubling Time?

> what is your % Free PSA?

> do you have a UTI? prostatitis? BPH?

With MRI (PIRADS 3/4) results:

> what is your PSA Density?

> any mention of perineural invasion, seminal vesicle invasion, or extra capsular extension?

What led to you having an MRI in 2022? What concerns led to this scan? In that MRI (PIRADS 4), was there any mention of perineural invasion, seminal vesicle invasion, or extra capsular extension?

In this recent 2025 biopsy, with both lesions being just Gleason 6(3+3), you can be sure that neither your urologist nor your oncologist will be too concerned about this.

Of all possible Gleason scores - 3+3=6, 3+4=7, 4+3=7, 4+4=8, 3+5=8, 5+3=8, 4+5=9, 5+4=9, and 5+5=10 - your 3+3=6 is the very lowest grade. In fact, there’s some debate in the medical community as to whether a 3+3=6 should even be called cancer (since a “3” structure cell can’t metastasize) and therefore shouldn’t be considered as a G7+. (That a 3+3=6 is a harmless benign tumor and shouldn’t necessarily be treated.) With a Gleason 6, they’ll usually recommend active surveillance, unless you have other known risk factors.

> with just a 3+3=6, you might not qualify for a PSMA PET scan, due to the negligible risk of metastasis.

> you should get a biomarker (genomic) test like Decipher, Prolaris, OncotypeDx, or one of a dozen others - whichever one your doctors use and your insurance will pay for.

> you should get a genetic (germline) test.

> others have mentioned a PSE test, an improvement over the standard PSA test,

Since urologists are usually surgeons, they will usually recommend surgery - not because they’re misleading you, but because it’s what they know best. (If all you have is a hammer, everything looks like a nail.)

> with low-grade, localized prostate cancer, there is rarely a reason to treat it quickly. Take your time and get the decision right. You’re the one who has to live with the outcome, not them.

> regarding the urologist’s statement of “radiotherapy would end up doing more damage and make future surgery much more difficult….” demonstrates that he is very old school. With modern radiation if there is a recurrence, you have the options of focal therapy, brachytherapy, SBRT, and even re-radiation (all depending on the nature of the recurrence). Salvage prostatectomy is a last and final option if and only if all other options have failed - and even in that case, palliation might be preferable.

> His statement that “surgery is the “gold standard” for this…” again shows that he is old school. Recent data show that with modern treatment methods, success rates between radiation vs surgery are statistically equivalent.

Yes, if you have no other significant risk factors, active surveillance is usually recommended.

> do you have any 1st-degree relatives with prostate cancer?

Regarding the medical oncologist’s statement of “…. “killing a bumble bee with a bomb….” - though I like the military analogy, I prefer to avoid hyperbolae and try to keep the tone as unemotional as possible.

As for the statement “…. since it’s possible I could die of something else first,” with just a 3+3=6, death would be the last thing on my mind. You’re gonna outlive all of us.

With sinilar numbers as yours, at 56y, I was on active surveillance with a 3+3=6 for about 9 years, giving me time to thoroughly evaluate all treatment options, take advantage of medical advances, and make a calm, informed decision. Take your time……

If you go on active surveillance, get a repeat PSA test in 4-6 months, and track all those numbers and tests mentioned above, you’ll be right on top of this, knowing exactly what’s going on, and be informed enough to make a treatment decision should any of those numbers head in the wrong direction.

You’ll do just fine.