I feel compelled to respond to you on this. I also was diagnosed at 65 with stage 4, Gleason of 4+3. I went for a second opinion to one of the few National cancer centers in our region. The oncologist/surgeon felt that surgery was my best option. I had previously seen a Urologist in our home town that strongly recommended not having surgery due to the risk that the cancer had spread to other areas in the body. At the National cancer center just prior to our leaving they asked if I would be interested in a fairly new scan called the psma scan with an isotope to be sure their was no other signs of cancer in the body. ( new scan FDA approved in July 2021) I agreed and once the results came back it was determined that the cancer had spread to my L2 vertebrae. If I had had the surgery as suggested I would not have been able to target this new found tumor on my spine. The decision was made then to have 3 high doses of radiation therapy to the L2 and 28 doses to the 6 tumors on the prostate along with Lupron ADT. I only tolerated the first dose of Lupron and completed the full course of radiation. Today I feel great and my second 6 month psa was 0.11. I just feel that if i had settled with the opinion of the second opinion (surgeon) I wouldnt be where I am today as far as my treatment. Hope the information is helpful!