HI,
Let me share my experience, which may have no bearing on your decision process. At 47 I had a PSA of 7, which suggested surveillance. By the next year it rose to 9 (rule of thumb is PSA should not be higher than the 1st digit of your age). And I was only 48 so an unreasonable reading would have been 4 to 6. Thus began biopsies every 6 months which were negative. By the time I was 50 the biopsies were every 3 months and my PSA was now 14. The last biopsy was positive in one sample, so I went ahead with the RPA surgery. The work-up included full body scan before the surgery. The cancer was contained within the gland and no lymph nodes were positive.
I am now 75 and PSA still below below .1. Looking back, by the time I was scheduled for the last biopsy I was feeling like a hunted animal, and told my wife that I wasn’t going to have any more biopsies. I insisted that the doctor was a hunter and I was the game.
Some things to consider: 1) Any history of urinary infection? This can affect PSA readings. 2) Do you hard exercise on a bike which can also aggravate the prostate gland? 3) Do you have a genetic history where a parent or grandparent had known prostate cancer? In my case all my relatives Dad and uncle were diagnosed with elevated PSA, but died from other causes.
Deciding which coarse of treatment is difficult due to provider bias. If the urologist is a surgeon, then surgery is the recommendation and if they are not then radiation may be the recommendation. Remember my data points were in 1995 and I suspect there have been improvements in treatment. Again, at the time of my treatment the post surgical problems of impotence and incontinence were the same after 2 years as far as the number reported. When it comes to treating cancer with an unknown rate of spread I believe that treatment should not be avoided. I can appreciate the roller coaster ride you are on as you face this very difficult decision. Best wishes, Keith

I strongly suggest you get Robert Marckini's book: "You Can Beat Prostate Cancer And You Don't Need Surgery to Do It." Make sure it is the 2020 edition. Take control of your plans yourself. Do not take the first counsel you get from a medical professional, deferring to his or her expertise. Do your research, and then decide on the course of action best for your circumstances. That is what I did and am happy I followed Marckini's advice. Best of luck.

I can understand your dilemma. It's been 2.5 years since my diagnosis. I had a PSA of 4.9 at the time of my biopsy. My urologist found a sample with a 4+4 Gleason score. That's considered high risk. My treatment was at Mayo and there was a big difference between treatment for high risk from moderate. If I were you, I would have another biopsy to determine the level of the cancer.

I chose Proton Beam radiation because it will cause less tissue damage. The main difference between treatment for moderate and high risk is the use of Antigen Deprivation Therapy like Lupron. There actually are alternatives to Lupron now that might be better, including a pill form that acts faster and shortens time of recovery.

The Lupron was used to shrink the prostrate and kill any cells that might be floating around your system. What caught my attention the most was the research that said my chance for survival improved from 60 to 80 percent with the use of Lupron with the radiation. I met a number of guys at Mayo who had moderate risk cancer who didn't take Lupron. That's a big deal not having to take Lupron. The side effects of Lupron are bearable, but if you don't have to go through it, I wouldn't.

Good luck through your journey.

I would talk to a radiation Oncologist in addition to the urologist. I'm 72 my PSA was 11.2 and my Gleason was 4 + 3. In July I went to Mayo, Rochester and met with both departments and decided to go with SBRT 5 treatments in 10 days. I chose radiation over removal because I didn't want to risk incontinence. In July I started on Eligard, an ADT to shrink the prostate, cutting off testosterone starving the cancer. In September I had the radiation and the only side effects were from the Eligard, Hot Flashs and night sweats plus needed Flomax for about 3 weeks. Returning to Mayo this mid-March to meet with my radiation Oncologist for a 6-month follow-up. Good luck to you.