I'd strongly consider getting the
Prostatectomy

That way a pathologist can thoroughly eyeball the prostate and its grade, extent, and whether any may have escaped.

My biopsies had me at the unfavorable 4+3 dominant. As you'll see below that became in a major way a far more favorable 3+4 on the prostatectemy.

Also worries about the sexual nerve bundles being preserved they can be so precise now that if they say one or both can likely be preserved, it's really a Doc's way of saying "in all likelihood".

The reason I chose the prostatectomy is I wanted to better know what I was up against.

I'm reminded of an adage that was drilled into my head as an infantry lieutenant training for Vietnam:
"Lieutenant-Always bring the Old Man bad news first. Good news takes care of it self."

Ironically Nam is probably where I got my dose thru Agent Orange (On permanent VA disability) On that score - maybe we shouldn't have been in that war. But once there - if they hadn't used Agent Orange there'd be a lot more names on the Wall. Including probably mine. So no tears here.

Here's my story
lymph-node-only oligometastatic metachronous prostate cancer Gg 2 with Gleason 3 at 80% and Gleason 4 at 20 %, . Under treatment for 8 years and PSA never exceeded 6.7

Prostatectomy 2018
--stellar pathology report
------Gg 2 with Gleason 3 at 80% and Gleason 4 at 20 %,
No epe, no positive margins, no vesicle invasion, no cribriform, no intraductal, left nerve bundle spared, N0, M0, adenocarcinoma

One draw back was +PNI

PSA undectable for only 13 months (little over a year) then BCR given owise stellar pathology report +PNI likely culprit.

Salvage radiation 2019 at PSA 2.5 without ADT and psa nadirs 0.2

NOTE ESPECIALLY THIS:

2021
PSA RISES AND IMRT W 6 MONTHS ADT DROPS IT TO UNDECTABLE FOR 4 MONTHS

SO IMRT WORKS!!!!

Psa rises to 3.7 and sbrt administered 08/2024

Psa rises to 3.7 and 3 month xtandi administered dropping PSA undectable again. The xtandi was monotherapy and testosterone was maintained at 350. So when xtandi wore off psa rose quickly to 6.6 but dropped to 6.2 in two weeks. Clinician believes further psa drops very likely taking psa back to at least 3.7

Importantly the second dose of xtandi for one month resulted in psa dropping from 6.6 to 0.5 with tesosterone maintained at 524.
Also conventional imaging has been negative all 8 years and psma pet scans continue to show only a few subcentimtere lesions with SUVmax never above 10.

Perhaps too long-winded.

But my main thought its my view the prostatectomy gives one the best understanding of where he stands (eg no EPE etc) and offers the possibility of a cure. But IMRT with ADT is also very effective as in my case taking PSA to undectable for 4 month's after it.

GOOD LUCK