@seekingclarity thanks for this post and the great questions. I will be following this thread as I am in a very similar situation, but a few months behind you. I had my first biopsy on 12/2 and it showed two G6's and one G7 (3+4). I am still waiting on my decipher results. I'm 57 and am going to take the next several months to research my options (surgery & if so where, tulsa pro, ongoing active surveillance, etc.), unless the decipher results indicate something potentially more aggressive than the "favorable intermediate risk" the dr. believes I currently have. To your question about PSA results, like the others have said, I think they consider it more of an indicator and not necessarily anything definitive. Also, it is quick, easy, and cheap, so it makes sense that the doctors would start with PSA. After several elevated PSA readings and a negative MRI a few years ago, my dr. recommended Iso PSA, which ended up being unusually high. From there we went to an MRI which was pirads 4, and most recently a biopsy with the results above. I think this is a fairly normal progression, even though I'm on the younger side. The one redeeming fact about prostate cancer is that it's fairly common and also usually slow growing. There's a lot of data out there, and most of us have time to weigh options and make decisions.