New prostate cancer diagnosis: Facing treatment decisions

New member 62 years old,
recently diagnosed looking for feedback on treatment.
PSA's
June 2023 2.76
June 2024 3.65
February 2025 5.28
May 2025 3.26
MRI in May 2025
2 Lesions detected
1 - Left peripheral zone 1.4 x .5 cm volume of 32 ml
T-2 score 3/5
DWI score 3/5
DCE-Negative
PIRADS V2.1 3/5
2 - left peripheral zone, posterior medial apex 1.0 x .7 volume of 21 ml
T -2 score 3/5
DWI score 3/5
DCE - Negative
PIRADS V21 3/5
Prostate Volume 36cc PSAD 0.09
4k score 29 don't have copy of actual test, that weas number given to me.
MRI overlay biopsy September 2025
A - Right Paramedian Apex -Benign
B - Right Paramedian Base - Benign
C - Right Posterior Apex - Adenocarcinoma 3+3=6
1 of 1 < 1.0 mm < 5%
D - Right Posterior Base - High Grade prostatic Intraepithelial Neoplasia (PIN)
E - Right Lateral - Benign
F - Right Anterior - Adenocarcinoma 3+3=6
1 of 1 < 1.0 mm < 5%
G - Left Paramedian Apex - Benign
H - Left Paramedian Base - Benign
I - Left posterior Apex - Benign
J - Left Posterior Base - Benign
K - Left Lateral - Benign
L - Left Anterior - Fibromuscular Tissue, No Prostatic Gland or Tumor identified
M - MRI #1 Left Peripheral Apex - Prostatic Adenocarcoma 3+4=7
4 0f 4
Pattern 4 10% 4 of 4 6.0mm, 5.5mm, and 4.0mm
60%, 60%, 30%
Perineural invasion ids present
N - MRI # 2 Left Posterior Apex - Prostatic Adenocarcoma 3=3=6
2 of 5
1,5mm and < 1.0mm
10% and < 5%
Decipher Test Sept. 2025
0.35
0.6 5 year
1.4% 10 year
1.7%15 year
12.0 Risk of Adverse Pathology
Have a consult set up for Focal Therapy
Debating between that and AS
Any insights would be great
Initially given choices of AS, Focal Therapy or Robotic Radical Prostatectomy