I Had 4+3 Gleason, unfavorable Intermediate, Grade group 3 and I chose Active Surveillance and after 2.5 years and diet & exercise, cut out all sugar, I am happy to report, my PSA went from a high of 7.21 spring 2024 to 3.59 last summer and now stabilized in the 4.40 range. I will be 73 in October and I am happy with my choice. You are fortunate to have only a 3+4 favorable, and with decipher of .46 I would think you would be an excellent candidate for AS. Of course each person has to make their own choice, but for me quality of life was number one, the medical industrial complex is geared to treat, radiation, surgery or focal therapy, thats the choice they give you.
I posted this below on this forum 3/12/24 almost 2 1/2 years ago

I am 70 years old ( as of October 23) my PSA had gone from 4.24 to 6.62 in 6 months so my urologist ordered a Parametric MRI and a 4K score blood test, MRI showed a 12mm lesion on the right side mid gland and came back Pirads 4, the 4K score was the maximum at 95% of clinically significant cancer. Sure enough the MRI Fusion perineal biopsy at Mayo Phoenix show 9 of 23 cores cancer, with 6 at 70% 4+3=7 and 3 cores 40% 3+4= 7 and 14 cores benign. I had the PSMA PET which confirmed the tumor on the right, but no other spread outside the prostate. I then had the Decipher test and it came back low risk at 0.38. I looked into surgery and met the Mayo surgeon, who said at my age and weight ( 250 lbs) I was not a good candidate for surgery and he reiterated that it was major surgery with serious life changing side effects and possible major complications. After learning all the details of the surgery, there is no way I would even consider it. My prostate was 50.4 cc about the size of a lemon, they cut the whole thing out and to make up the missing 2+ inches of the urethra they pull the bladder neck down and the urethra up shortening your penis 1-1.5 inches, the cancer returns in about 20 - 30% of surgeries and you need further treatment like radiation or God forbid ADT and hormones. Radiation also has serious side effects and Erectile Dysfunction in 20-40% of cases, plus possible bowel problems. I then looked into Focal Therapy, talked with my Mayo Urologist yesterday, was really depressed that even the focal therapies like Hifu have side effects, ED in 20% of cases, possible rectal fistula, urine leaking into the bowel and you need surgery and have to wear a bag, also you have to have a Foley catheter for 1-2 weeks. I am looking into the Tulsa Pro which they do in Rochester , not in Phoenix. Considering my relatively low PSA at 6.62, Low Risk Decipher score of 0.38, tumor grade T1c and small volume tumor less than 1cc or 2% of prostate volume, I am considering Active Surveillance, at 70 my PCa may never metastasize in the next 10 years and I would more than likely die from some other cause. The ProtecT study in the UK shows no difference in mortality with Intermedate Risk patients over 15 years . 1/3 had surgery, 1/3 had radiation and 1/3 Active surveillance. Quality of life is much more important to me than quantity,