Personal, non-medical opinion: I would have prostatectomy at a center of excellence or by a very experienced Urologic Surgeon. And soon.

Removal of cancerous prostate while cancer contained within capsule was my wish; unfulfilled because some cells had escaped (EPE), and now Radiation and Hormone therapy to chase down the lousy bastards.

And I know that medicine is balancing treatment vs overtreatment. Also, my physical recovery from surgery at 72 has been terrific, so I am a RP advocate (continence has been excellent; ED significant changes and a work in progress).

Very personal opinion of 1 (some might say radical).

Note: My MRI suggested cancer contained within prostate capsule and my Gleason scores were higher (8s and a 9), last 4 PSA results were 4.6, 5.9 and 7.5 at time of MRI (over about 2 yrs).
Would surgery earlier have eliminated the cancer? Who knows. But now I am chasing cancer cells.