The word active surveillance scares me. I was told when I found my prostate cancer I was good for 10 years before I had to worry about it. Three years later they went to my bones and metastasized. Now it’s in my ribs, my sternum, and my scapula and my back and shoulder lately, they would’ve taken the thing out or radiated it back in 2018 I wouldn’t be fighting this right now. Nobody told me you could go to your bones and do all that or I would’ve told him to take it out. Then one thing I learned from all this is get a second or third opinion , don’t wait for it to go to your bones because there’s no coming back from that. I’ve had radiation. I’ve had chemo and more radiation. It all could’ve been avoided. Good luck. My prayers are with you. Dave

You appear to be on the cusp of the treat/AS inflection point.

I found these articles to help me when I was at a similar crossroads, regarding age, PSA levels, and the use of the free PSA:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923265/ ("Age and prostate specific antigen level prior to diagnosis predict risk of death from prostate cancer" - review of several 100,000 men in VA database monitored over decades)

https://www.nejm.org/doi/full/10.1056/NEJMoa2214122 ("Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer" - UK study of 1600 men randomly assigned to AS, Radiation, or Surgery)

Also, talking with a medical oncologist (not a urologist) specializing in prostate cancer helped confirm my own decision. An in-depth 45 minute conversation with her was very helpful.

Applying the thinking I used at the time I had my biopsy, with your numbers, age, and cardiac status, I would have opted to continue AS. On the Plus side: relatively low, (and falling) PSA, Gleason (3+4) grade group 2 all sound reassuring for the next year. In my thinking, the free PSA percentage is only useful in predicting the probable presence of cancer. You already know the cancer is there, so you know how that bet played out

The key question in my mind would be, "How willing am I to undergo the side effects of radiation and possible hormone therapy?", compared to the likelihood I would die of the disease in the next 5-10 years. I would (personally) bet the cancer is not aggressive, and I'd rather live those years without the risk of bowel dysfunction and worsening penile erectile status. You may have different values on those questions than I did.