Opinions wanted

3+4=7 Gleason score July 25
.6 Decipher score July 25
1 PIRAD score July 25
9.36 PSA June 25

I was told I am on the borderline between treatment and more active surveillance. I was told radiation treatment on my 81cc prostate could possibly make urination harder, its not that great now.

Another thing that bothers me is this finding from my 2023 biopsy: "A. Prostate, right base, core biopsy:
- Prostatic adenocarcinoma, Gleason score 3+3=6 (grade group 1) involving 1 of 2 cores (1.5 mm, 10%)
- Perineural invasion is present"

When we discussed the biopsy findings in 2023 he didn't even mention Perineural invasion. Ive since learned that's significant and not good. My latest biopsy did not detect Perineural invasion. But these biopsies are hit and miss.

I got a referral another doctor but I cant see him until October. I'm thinking active surveillance is too risky? It might have already spread outside the prostate. My cancer isn't even visible on the MRI though so some treatments are out. Whats left, radical prostatectomy? I am 68 years old healthy and I have a penile implant so impotence is not a big concern. Incontinence is though.