How important is it to know the exact clinical T stage?

No. However, it can be from the biopsy and PSA.
3+4 with all lesions on one side is usually 2b.

If you're considering focal therapy, a genomic risk test like Decipher, Prolaris, or ArteraAI would be far more important than the exact T2 stage.

I was a candidate for focal therapy with a single (unilateral) 3+4 (20% pattern 4) lesion, but my Decipher score came in very high at 0.86 and that took focal therapy off the table. I opted for RALP and have recovered well.

Also worth noting that some well respected oncologists do not view focal therapy as curative, but rather a more "active" version of active surveillance. This is UCSF's position, for example. Here's a 15-minute presentation from a conference earlier this year that's well worth watching:

I definitely would get a decipher test done in my case I had 2 cores 3+4 and was considering focal therapy but my decipher came in at .86. Also had a .8cm lesion but t1c, next is pet scan in 2 days than Urology surgeon in one week, I am leaning towards sbrt but now because of score 6 months adt.

It is unlikely a DRE can tell anything, but that there are lesions inside the prostate. You need a biopsy along with the MRI to really get a T. If you have a prostatectomy that could even change the result.

Welcome to the group nobody wants to belong. There are many things to learn and I’ve found this site to be invaluable in that pursuit.
I’d also suggest picking up the book by Dr Patrick Walsh 5th edition (Amazon).
My situation is similar and was given AS option until Prolaris put me into unfav interm. Now waiting for Pet scan to narrow down the options.
I think genetic testing and perhaps Pet would be the best direction at this point.

In the past year, I have gone from not knowing much about prostate cancer to learning a good bit. I am 4-days post RP surgery, so lots more to learn.

You have important info from 1st biopsy. 6 out of 12 cores were positive. With 4 cores at 3+4. This is an indication that treatment may be necessary in the next few years.

Your biggest tasks are to obtain more information to guide decisions. Some are:

1. Your age is young. This is Concerning having 3+4 and you are young to suffer treatment side effects. Genetic testing is important. Do you have any BRCA or other concerning genes.

2. Find an oustanding treatment center and the best Surgeon and Radiation Oncologist anywhere close to you. Traveling 4-8 hours is nothing, if needed. You need to excellent care facility, excellent Doctors and feel comfortable with the process of you self-advocating to understand, determine, and execute. Spend time now, going thru this vetting process.

3. Decipher or similar test provides information. So a good test to request.

4. As you proceed further, more tests (PMSA-PET, Prostox, etc) can provide more info in the future.

Best wishes as you go thru this part of life.

Also, definitely consult and study your options for focal treatments. Find great centers and Doctors for evaluation of Focal Treatments.

For me, I would be willing to travel anywhere in the country, If I felt focal treatment was a good option.

Best wishes.

@notpetecrowarmstrong Hello, I am interested in how you are doing after RALP? How long ago, and how are you now? How is your continence and erections? I am scheduled for my RARP consultation this week, and have met with my RO. Both are supposed to be good options. Your history is much like mine. I am leaning towards RARP but am not sure at 68 years old. Any thoughts you could share with me would be appreciated.