I had Pi-RADS 5 at my first MRI to confirm cancer with two tumors and possible ECE.
After a second opinion at Mayo Rochester it was changed to one tumor at Pi-RADS 4 with ECE.
After my biopsy the projected Gleason was 8 (4+4). My PSMA PET/CT showed no spread.
I had a robotic prostatectomy with nerve sparing. All margins, lymph nodes, etc. were clear. Some extra tissue around the prostate was removed. I have no idea how much but it didn't sound significant.
One benefit of surgery is being able to run a pathology report. Mine came back as Gleason 7 (4+3) vs 8. This can aid in the determination of follow-up treatments. I am having no radiation at this point and will be doing my first PSA test in 3 weeks.
I preferred to start with surgery and follow up with radiation if required since they could properly stage my cancer and any radiation follow up would be more targeted with fewer negative side effects. Be sure to read up on them if considering radiation as you can have incontinence (urinary and bowel) and ED as delayed side effects. My surgeon has over 20 years of robotic prostatectomy experience and was not overly concerned with my ECE as it seemed confined to the surface of my prostate. My radiologist was quite comfortable with a surgical choice and my proposed surgeon. My incontinence and ED recovery are proceeding as predicted. As everyone will tell you, it is a complicated choice to make and many variables to consider and the stories of everyone in this group will vary significantly. Best of luck.