I am in the middle of this process, so my knowledge is limited. I am almost 61, so similar age.

I think Decipher is becoming more mainstream and being ordered earlier in the process. My Decipher was ordered on 1st visit after Biopsy. Main reason was to help decide between Active S. versus treatment. My biopsy was gleason 3+3, but with a good size Pirads5 lesion.

I do not think (from my studies and discussions with surgeon), your decipher score will dictate a more aggressive RP. Decipher is a piece of the puzzle, to help determine treatment plan(s).

My decipher was a 0.48. Since my mri showed a Pirads5 lesion and Decipher was in the intermediate range, my doctor was able to get insurance to cover a PSMA PET scan. This was to provide another piece of information. I would see if your surgeon or radiation oncologist could get a PSMA PET scan approved/completed. This will be a bigger factor for nerve sparing. If the PSMA PET also shows no cancer outside of the prostate, this will be info used in treatment decisions.

Biopsy mapping and MRI will be largest factors on location(s) of lesion(s) or cancer cells (if no lesions are visible on MRI). If you have no extracapsular extension or are not close to the bladder, surgeon should be able to perform nerve sparing (in a lot of cases, I think).

In April, I will have a 2nd biopsy to try and determine is my Pirads5 lesion Gleason6 or Gleason7. Did initial Biopsy miss higher gleason? MRI, biopsy, decipher, PSMA, etc are are pieces of info to try and guide treatment decisions for each unique individual.

With my limited knowledge, you may be a good candidate for nerve sparing RP with no ADT. You could also choose radiation, weighing the risks of how to treat if cancer recurred in the future.

Best Wishes.