I think my situation is close enough. Apologies in advance for the length. I'm 63 y/o, dx in February with a couple of 3+3 and a 3+4 (20% 4). I'm healthy with no other medical problems, and like you had recently begun exercising, losing weight and feel better than I have in many years. The private urologist (who doesn't do RARP) sent me to a urologist in the group who ranked surgery last among the 3 options and radiation and AS as about the same. I thought this was very telling - a surgeon recommending against surgery. [I have a medical background but dont' think that influenced him.] The group's radiation oncologist recommended radiation. The referring urologist ranked surgery first, radiation second, and AS last. I would have probably chosen brachytherapy offered by the RO, except I thought the guy was a jerk and I simply didn't trust him.

Next appt. was with the Multidisciplinary Clinic at a well known Baltimore institution. The RO and urologist both recommended AS with a repeat PSA at six months (was unchanged) and repeat bx at the one year mark, in February 2024. I trusted them and am happy with my decision today. BTW, genetic testing (free for prostate CA patients through the PROMISE study) showed no mutations associated with prostate CA and tumor genomic analysis showed low likelihood of progression within 10 years.

So, to your specific question, the private urologist with ~800 RARPs recommended against surgery for my 3+4 cancer. And the big-name academic urologist who's done a few thousand also recommended against surgery. At least for now.

Lastly, I want to validate your feelings. Initially I was bewildered, but then was angry – not at the cancer so much, but that for intermediate cancers like mine, there was not enough research over a long enough time period to know which is best. And there still isn't. Instead, we have "shared decision making" which means you decide what treatment receive. If you end up with refractory incontinence or ED from surgery or radiation or progression on AS, hey buddy, it was your choice.

I'm not as angry now, though still annoyed with the state of prostate cancer research. The consolation is that for most men, it's a very slow growing cancer. Unless theres's more to your story, you should feel comfortable taking your time, doing more research, getting other opinions, and letting your feelings settle before committing to a treatment path. A sincere good luck to you!