Going on ADT is the one thing you can do that will drop your PSA. It could take it down to undetectable, But if not that at least quite a bit. ADT also stops the cancer from growing and spreading.

Of course, there are a number of side effects of ADT.

The easiest thing to do would be to get a prescription for Orgovyx, A one time a day pill. In the beginning, it seems to have somewhat Fewer side effects for some people.

You could also start using the estradiol patches, Which work just as well as ADT and has fewer side effects. Doctors are not really up on using it yet, however

That is strange that they did not want to do MRI. How did they perform biopsy than ? Blindly going around instead directly into the lesion ?
Also, you should do PSMA scan to see if your cancer has escaped the prostate.
What is your gleason score ?
Did they do Decipher test ?
There are many things that need to be done ASAP before you start any treatment.

Please find better doctors and go to a big center of excellence that specializes in genitourinary cancers. You need much better care than this ...

Wishing you all the best < 3

Is it possible for you to go to a center of excellence and get treatment there? It sounds like you’re not getting enough options where you’re at. There are treatments besides surgery and radiation.

I would think they would want to have an MRI to find out what’s going on. This may just be a financial decision on the part of your doctors. Another set of doctors may determine totally different choices.

Did they give you a Gleason score on the core that came back positive? Did they tell you what percent positive it was and what grade it was percentage wise? These are things that can help you determine whether or not you can stay an active surveillance.

Prostate cancer frequently causes no pain and you will not even notice it’s there until one day it does. At that point, it is quite advanced usually, You don’t want to go there. See another doctor and get that MRI.