This paper looked at all the factors that you likely already have: https://www.nejm.org/doi/full/10.1056/NEJMoa2214122

My experience with active surveillance —> I was diagnosed with PCa in early 2012 at 56y with a localized, 3+3=6, PSA of 4.2, and chose active surveillance. I made a commitment that should my PSA ever reach 10, or my Gleason ever reach 7, or my biomarker (genomic) test ever have a negative result, that I would seek active treatment.

One of the understandings I had with my doctors was that quality-of-life and successful treatment were equal priority for me. That set the basis for us working together and agreeing on a treatment plan.

I was on active surveillance for about 9 years. During that time my urologist (a surgeon) game me referrals to specialists: focal therapies, brachytherapies, and external radiation therapies. I attended webinars/seminars (too many to count), and became (what I refer to as) a “student of prostate cancer.”

Eventually, my Gleason did reach 7 and a biomarker test indicated that I had “exceeded the threshold for active surveillance.” By then, I had already made my decision.

So, at 65y/o (in early 2021) I decided on 28 sessions of proton radiation + 6 months of Eligard + SpaceOAR Vue. PSA now varies between 0.35-0.55; most recent PSA test was 0.473.

Good luck with your decision!