I had a similar experience and, at just 54, I was in treatment territory last year. Here is my experience, glean from it what you feel helps, but I think you and I are kind of peas in a pod here:

My PSA was rising but was never 4+ until last year, 3.78 as my highest until then and I ended up with over 4. This prompted all the normal things: DRE, biopsy, MRI, etc. The biopsy was similar to yours, lots of 3+3 (not considered "cancer" much anymore) and some 3+4. Due to this, I was suggested for active surveillance. At the same time my urologist sent my biopsy in for a Decipher, which came back 0.68 - which is risky and aggressive cancer. He recommended surgery.

From here I went to 8 other doctors for opinions in urology, medical oncology and radiation oncology. To a doctor they said "surgery" and their reasoning was the same: I am young enough to recover quickly and young enough to almost positively see side effects from radiation later in life (other cancers, bladder issues, bowel issues, etc). So, I had a quorum, everyone in agreement from multiple hospitals.

I asked if I had time to prepare, and I did, so I took 4 months and supercharged my already active life into hyper active. Massive core training and strength training incorporating pelvic floor exercises and therapy. I was giving myself the best chance of success under the knife and speedy recovery afterwards. I also gave up drinking and any "fun things to eat", this was my life and I was serious about this.

I had surgery January 28, 2025 and in under an hour after waking up, I had an erection - something even the urologist was shocked to find out about. After my catheter came out I didn't have a single millisecond of incontinence, also somewhat rare. I attribute this outcome to having nerve sparing surgery and working my ass off for months to prepare properly.

I investigated all of the non-traditional (i.e., not surgery or radiation) treatments, none of them satisfied me. I'm glad, in retrospect, that I had it out because it's the only time they can fully evaluate your prostate and your cancer. Having pathology done on the entire gland revealed that my cancer was far more 3 + 4 than the biopsy indicated and that I was even higher risk - my cancer stage was upgraded. If I nuked it then I'd never have known.

I spent nearly a year researching every treatment option, every long term side effect - my head also was swimming and I was relatively terrified (and I'm a combat veteran and thought I had no fears left). I could never find much good news on outcomes from real people, only the statistics that 90% of men get over any incontinence and/or ED from surgery within 18 months.

My choice was clear, my outcome optimal - I have zero regrets on the direction I took. I know this might still rear up at some point but I stick around here and other places to be the voice of success, of good news where none seems to exist. You can do this, you will get through it, and there are a LOT of us here to help answer your questions. Remember that 1 in 12 guys get this before aged 60 and 1 in 8 after - it's not an uncommon cancer and it's come a very long way from the near guaranteed death sentence it was 30 years ago.