Hi @rsun,
I had two MRI after many years of relatively consistent PSA, mostly 4, once 5, and thought the first was a mistake, in Jan. 2023. I followed up the PI RADS 5 reading with a second confirming MRI in Mar. After researching biopsies, I saw no need to take the infection risk of TRUS and Dr. Sonn performed TPUS in June. I tolerated the procedure mostly without concern, except for getting faint, which I believe was due to contact with the vagus nerve, that I'd experienced before with a sigmoidoscopy. All of my cores showed 3 +4 =7 except: Left Posterior Apex Peripheral Zone (PIRADS 5) Prostatic adenocarcinoma, Gleason score 4+3=7, hence my overall GS is 4 + 3 =7. I then followed up with a PET Scan, which was negative and a Decipher Grid. I had previously done some genetic testing that was of no value for PCa.

After consulting a variety of Urologists and ROs, I decided on a tri-modal of Orgovyx/ADT (4 months); Cyberknife boost @ UCSF; EBRT @ Stanford. One consultation was 'off the record', with a retired Urologist and current CMO, that provided a candid view of alternatives. I had planned to consult with Mayo, however, laws prohibited a video visit and I was content with my regional facilities. Mayo mostly uses Proton radiation vs. Photon and I can't find any convincing evidence that Proton is superior, albeit there will be a great deal of debate on this topic. According to the PCF, "Protons are similar to photons (traditional x-ray
radiotherapy) in many ways. However, proton beam
therapy has not been shown to improve cure rates or
quality-of-life outcomes over other forms of radiation
therapy, and may actually increase rectal side effects.
There have been no completed head-to-head trials
comparing proton beam radiotherapy to either surgery
or traditional x-ray (photon) beam radiotherapy"

I am about to begin EBRT soon at Stanford and have fared well so far. The worst bit has been weak urinary stream and greater urgency that is helped by Flomax, I am managing on one per day and pray that continues.

Best of luck!