@sulatnasteve You do not have to travel to get a second pathology opinion. jeffmarc (posted video) can give you details. Cost is $500. Primarily want to confirm the percentage of type 4 in your biopsy (I take it this was targeted at the PIRAD4 lesion). The assignment of a score is part art, part science so 2 pathologists do not always agree. Want someone with lots of experience in prostate cancer. Also to make sure there are no aggressive features in the cells. All of this is to make sure that there is a low probability of progression on AS for the next few years.

If you decide on surgery than you should travel since the skill of the surgeon becomes your destiny to minimize ED and incontinence. Should go to center of excellence. Fred Hutch in Seattle (UW) is probably the closest but also in SF & LA areas on west coast. Same may go for focal treatments although there the risk is more poor execution leading to a recurrence requiring radiation or surgery. Even with radiation they are now doing SBRT (5 treatments over 10-12 days) so not as long as traditional IMRT of 4-7 weeks.