@ginger38314

My situation was nearly identical to yours: exact same .86 Decipher score and a low-volume 3+4 cancer in two cores. I opted for surgery largely because of my age (51 at the time): two radiation oncologists at two COEs both said they strongly recommended surgery over radiation given my youth and general health. I'm 14 months out from surgery and PSA remains undetectable, and functional recovery has been good, so I'm happy with my decision.

Of note, my post-surgical pathology found both large cribriform architecture and focal intraductal. Both of these are markers of aggressive cancer, and neither had been seen on needle biopsy. But the tumor volume and grading was the same as on biopsy, my margins were negative, there was no detectable escape from the prostate gland, and 5 lymph nodes were clear. Still, the high Decipher score and the cribriform/IDC-P had me uneasy.

You write "Everything thing seemed favorable with Gleason score and only a.8cm lesion
so very bummed out at this point". I felt similarly, so let me share something one doctor said to help me contextualize it: he said that "you had a very small amount of a very nasty cancer, but all indications are it was contained and your surgery was successful."

Everything other than your Decipher *is* favorable, and you're looking at favorable odds for successful treatment. Your cancer may be genomically aggressive but you seem to have caught it early enough where it's quite likely curable. Be grateful and put your trust in your care team to guide you through the process.

@ginger38314 Is your Oncologist a top tier GU Medical Oncologist, not a regular Medical Oncologist? It’s a lesson that I wished I had learned about earlier.