I'm not a physician, but one thing is for sure...you have a lot of time to do your own research and consider all your options....so don't let anyone rush you into a decision.

I was 66 y/o when my PSA increased from 5.06 to 7.8 in 6 months. At that point my GP referred me to an urologist. Five months later my mpMRI showed PIRADS 3, PIRADS 4 and PIRADS 5 lesions and my PSAD was 0.18...I had a targeted MRI TRUS biopsy two weeks later.

The biopsy indicated the PIRADS 3 lesion was benign and the PIRADS 4 & 5 lesions were low volume Gleason 3+3. A 12 core systematic (random) biopsy, performed at the same time, revealed two low volume Gleason 3+4 cores. I never received an entirely satisfactory answer as to how this could have happened, however, the best explanation seems to be that the two more aggressive cores were taken from lesions that were just too small to be seen in an MRI, so called "MRI invisible lesions". Of course, I probably should have had my pathology reviewed to determine if the 3+4 were indeed that....I've heard of cases where a pathological 2nd opinion can downgrade a Gleason score.

In any case, my Decipher score came in at 0.22. I was given potential treatment options and active surveillance was also presented as a viable possibility. I implemented an "aggressive AS" plan, based on the many hours of research I put into the subject. Being a retired chemical engineer who had spent 45 years doing technical research work, made me a prime candidate for the task...but that's just me....

That was over two years ago...I'm still on active surveillance.

In fact, my latest PSA was 5.76 and a 12 month follow-up mpMRI indicated the PIRADS 3 and PIRADS 4 lesions were not able to be visualized; while the PIRADS 5 lesion's T2 and DWI/ADC signals were reduced from "moderate" to "mild". My PSAD had also dropped to 0.13.

We just moved to a new city and I had a first appointment with my new urologist. I think we are on the same page, he's already provided some new ideas and I'm willing to go with his advice concerning the best plan for monitoring my PCa.

My experience (of course) is anecdotal and I'm aware that a small percentage of men, with low PSA levels, can be found with more aggressive PCa. So each man needs to consider all his biomarker data and review it with a well chosen physician who you are willing to trust with your care.

For better or for worse, there is no "one size fits all" answer for men dealing with the unpredictabilities that come with the lead up, the diagnosis and the follow up options related to prostate cancer.

All the best as you consider your best path forward!