You have a high decider score and a high percentage of cancer in the 3+4 cores.

PNI Is extremely common. I had it and I’m still around after 15 years. I find it in a lot of biopsies. While they say it is aggressive, people usually have more aggressive things in their biopsy than that. Yours doesn’t seem to have much more from what you have posted. The thing is PNI can be pretty much resolved by surgery or radiation.

Because of the high decipher score, I would consider Surgery. The reason for that is you have a high chance of a reoccurrence. If you get a reoccurrence after surgery, you can have salvage radiation. That is not true if you have radiation first. You would want to ask your doctor if they can spare the nerves if you get surgery. Of course you can have SBRT radiation to zap metastasis that pop up if you have radiation, but that’s all.

If you had said you had a 3+4 and your decipher score was .2 I would say go for the radiation, but that’s not your case. You want to have a long progression free survival. Surgery would give you a better chance.

You have a PIRADS-5 Which is definite prostate cancer. While you are a 3+4 like I was, after surgery, I was a 4+3. I know a lot of people that found they had a higher Gleeson score after surgery. Would yours be higher after surgery, considering the high percentage of cancer in your cores and The high decipher score, it is more likely.

Speak to a radiologist and a Urologist who does surgery. Try going to a center of excellence and see What they feel would be the best treatment. It can’t hurt to get a second opinion since you want to wait.