It is really important that you find out whether or not you have small or large cribriform. My brother had SBRT radiation A couple of years ago and his biopsy specifically says Small cribriform. Five sessions of SBRT and he is fine two years later.

PNI It is so common it almost ridiculous. Here I am 15 years after diagnosis, Had surgery than radiation then drugs for 9 years. Even though I have BRCA2 The PNI recognized in my biopsy, made absolutely no difference. Same is true for almost everyone else PNI is not considered a Recurrence problem.

Since you are young (I had surgery at 62) Radiation may be preferable. You should look into proton radiation, While the chance of having other cancers due to radiation has become much lower Because of the better techniques of radiation, Proton radiation causes the least amount of issues with other organs being radiated.

That decipher score does show there can be problems in the future.

Getting a second opinion may make sense for you. Going to a center of excellence can expose you to many more doctors, which will give you more options.