Can anyone please find a moment to help decipher our MRI report?

Di341: Sorry about your significant other. Its scary. It helps emotionally to be prepared given his initial diagnosis in 2019. Try and get backup diagnoses from as many people as you can, including outside your treating hospital. I went to 6 radiation oncologists 4 of them in centers of excellence and the treatment recommendations were slightly different. There are some grey areas in the Dr's process so collaborative patient/significant other involvement is important. I myself started out with Gleason of 3+3 and had 5 radiation treatments in February. Here are some of the places and reasons I looked them up:

Nccn.org
Many doctors follow their guidelines, and it is there for doctors and patients
Decipherbio.com
Takes a slice of the biopsy which helps evaluate aggressiveness and modes of treatments (acts as a backup)
Viewray.com
MRI/Radiation machine combination unit (this is what I ended up using)
Mevian.com
Proton therapy radiation machine
Globalroboticsinsititute.com
A doctor Patel, I looked into when I was considering prostate removal in Celebration Fl. with 18,000 prostate removals.
pcri.org (some on this web site have recommended with lots of dr videos).The Prostate Cancer Research Institute helps men and caregivers research their prostate cancer treatment options.

The biopsy will tell you a lot more. I was put under for mine. No issues during or after biopsy so I recommend the knockout. Same as a colonoscopy anesthetic. If the biopsy definitively proves there is PCa most likely you'll be given 2 options. RALP or some sort of radiation. I chose RALP last year and have had no issues with incontinence. I was 60 years old at time of surgery. Your urologist should send you to a surgeon and an Oncologist so both can give u the pros and cons of each option. Radiation itself can be applied in many different ways. I chose surgery because if the PCa comes back (Biochemical Recurrence) it is easier to get spot radiation to kill it. The surgery after radiation is more difficult. Both options seem to have the same level of success (both good). If you choose surgery make sure the surgeon has plenty of experience with the Robotic system. My surgeon performed 3/week over the last 17 years using the DaVinci system. If your mate is older the Radiation route may be better as there is less of a chance of incontinence issues. If the biopsy comes back with PCa you may want to start Pelvic Floor exercises (Kegels) as this will help lessen the chance of incontinence. I know there is a lot of decisions to make but take them one at a time. Your partner will be fine.

After I was in your approximate situation, I learned a few unexpected things. 1) There are significant differences in the quality of a mpMRI (multiphasic MRI) and 2) there are significant differences in their interpretation.
But then there are also significant differences in the quality of biopsies, first as to method--MRI/ultrasound guided targeted biopsies, transperineal vs transurethral, number of cores, etc.
Unfortunately, in all these cases the cancer found is almost certainly there, but more cancer may be there than is found. Since the MRI indicates you are already looking at an intermediate grade cancer, you are likely not going to be looking at "active surveillance," and as others have said, you will be looking at treatment recommendations involving radical prostatectomy and radiation. (On the other hand, your PSA is quite low for this level of cancer. This may be hopeful, but it is not necessarily a good thing.) Likely, again as has been said, you are hoping that the cancer has not spread beyond the prostate yet, and therefore radical prostatectomy (sometime abbreviated as RALP and other things, again depending on the method) will be your next step, followed by the hope that further treatment will not be required for some time and the quality of life will be higher rather than lower. I wrote a couple summaries about diagnosis and treatment that might be relevant for your situation here: https://teamspinella.wordpress.com/2022/01/25/on-the-treatment-of-prostate-cancer/ (the other article about diagnosis is linked in the first paragraph.)
Given your situation, moving quickly may be of value. I say this because this is not the common wisdom for dealing with prostate cancer generally.

Thank you so very much for such a detailed suggestion response. I am seeing that your decision of MRI/radiation seems to be in favor these days.

Thank you for your thoughtful answer. It helps to look at the different journeys.

DI341: One other note. The type of radiation machine and its margins are REALLY important in terms of quality of life and side effects. The less that gets radiated the better off your significant other is. Secondly, my own feeling was even with 3+3 Gleason and a PSA of 10.2 and one center of excellence RO saying "you may want to monitor", I would not have because it is an inexact science and nobody knows whether it will spread or how fast, although the Decipher test was helpful for both my final decision and multiple RO's who looked at it.

We both feel that moving forward with treatment is the next step. I know that the DX of what type he has according the biopsies will help determine it. He is very proactive and not willing to take chances letting it grow further. Thank you again!!

Another questions for you, if I may.... You mentioned, " Likely, again as has been said, you are hoping that the cancer has not spread beyond the prostate yet, and therefore radical prostatectomy will be your next step". Is that the prevailing wisdom over radiation only, taking into consideration that radiation has less of a chance of incontinence issues? Believe me, we only want to do what is most prudent for longevity.

@di341. In my case my PSAs were hovering around borderline for a 68yo. After a third high reading in three months I went to a urologist who performed a 12 sample biopsy. That procedure was so simple and fast I honestly didn't even get undressed! "Pull down your pants and jump up on the table."
Results showed 4+4 Gleason 8, or advanced PC. It was decided that no matter which option I choose we'd need to shrink the tumors first so I started on Lupron and sent for an MRI. The MRI was to determine if the cancer had spread. Luckily it was still contained in the prostate so it seemed I was a candidate for either surgery or hormones/radiation. The radiation oncologist showed me a website developed by a panel of oncologists which actually had a flowchart where the doctor plugged in your data and it determined your best plan of action. Mine predicted the same results with either treatment. Then I saw a urologist/surgeon who confirmed the same outcome BUT recommended against surgery because of my hypertension. Turns out you're tipped backwards for about 2.5hrs during the surgery and that's hard on your heart. So 20 radiation treatments and 2yrs of Lupron it is. One more Lupron to go. PSA is undetectable at this time.
Talking to men who have had surgery v hormone therapy I wish I'd been able to have surgery. While Lupron seems to have controlled the cancer the side effects have been hard on me.
Best of luck to you and continue to reach out to groups like this

Thank you for sharing your experience with me. It’s all very helpful.