@jaygk Thanks. Given your age I think some sort of radiation is appropriate.
Look at my profile here and at
https://www.inspire.com/m/Toolbelt/posts/
to read about my SBRT treatment of 4+3 with Decipher of .81.

@jaygk I just had a TULSA consult from the one group that does it here in St. Louis. They’ve conducted about 70 procedures, which honestly didn’t sound like a lot to me. I’m 58 (so on the younger side for all of this) and G7 (3+4) but with some cribiform and cores with around 50% 4. I’m intermediate risk, but one urologist considered me unfavorable. Most docs seem to think I’m right in the middle of favorable and unfavorable because of the cribiform and amount of 4. PSMA PET did not show any spread. My PC is primarily on the left side, but there is also some on the right, so I would need whole gland treatment.

The TULSA doc said they would be willing to treat me, if I understood the risk of recurrence. I believe that was primarily because of the need to treat the whole gland and my relatively young age (it’s nice to be considered young somewhere!). It sounded like he would be more optimistic about TULSA for me if I were older since the data only goes back a few years.

I’m not sure, but am guessing that’s why Medicare readily covers TULSA (older patient population), but private insurance is iffy (generally younger patients).

Needless to say, that didn’t give me the warm fuzzies I was looking for, so I’ve ruled out TULSA for myself. Still glad I did the consult, and appreciate the doc’s candor. I’m waiting on prostox results ordered by a RO at Siteman Cancer Center, but am leaning towards SBRT, or possibly brachy.

Hope this helps. All the best to you in this very confusing decision-making process.