How did I decide....

Keep in mind, it was January 2014, choices were pretty much binary, surgery, brachytherapy. Imaging was not even that, CT and at less than 20 PSA, unlikely to "see" anything.

I chose surgery, offered the "best" chance of a cure and if it "failed," radiation was on the table. If I went the other way, it was not. In my surgery consultation, I told him that if he got in there and there was cancer in the nerve bundles, take them out, my goal was a long life. I understood the risk of incontinence and that even if the nerves were spared, erections would take time, be different, no ejaculation...

The good news, no ED, no incontinence. The not so good news, it didn't work, 18 months later, BCR....

Today, would I make that same decision? I don't know.

Why, so many options brough about through advances in treatment and imaging by medical research. I have friends who opted not to do surgery for all the reasons other members on this forum mention in their responses. They have chosen radiation, doublet therapy...Have their choices been successful, yes, in the short term, what about longer term, too early to say.

Have you looked at and discussed with your medical team, the NCCN and AUA guidelines, done your homework on treating Treatment for synchronous metastatic hormone-sensitive prostate cancer? Have you met with a medical oncologist with a background and experience in treating PCa?

You could punch in your data such as the MSKCC nomograms to calculate the probability of "success" in surgery?

Finally, keep in mind that even if the MRI and PET (you don't say which one, hopefully a PSMA, not the tired old conventional one) don't show spread outside the prostate, there may be micro=metastatic PCa too small to be seen by even the most sensitive imaging today.

Is there a rush to make this decision, who is rushing, you, your medical team, why?

Was it I, what would I do?

I would bring in the medical oncologist.
I would ask for the PSMA PET scan
I would read through the NCCN and AUA guidelines
I would read through patient resources on sites such as= the PCRI and PCF
I would review Dr. Kwon's series of lectures on YouTube.
I would discuss doublet and triplet therapy with my medical team

You're asking for what is the "right" answer, wish there was one. There are good decisions though!

Kevin