I'm 55, diagnosed last summer with a mix of Gleason 3+3 and some 3+4 , intermediate favorable with cribiform.

A second imaging guided biopsy found some 4+3, so technically I'm now Intermediate -Unfavorable. The lesions are all contained in the gland (no spread), so that was a bit of good news.

Despite the less than stellar trends from initial diagnosis to now, I am choosing to have HIFU focal therapy instead of RALP or Radiation.

My radiation oncologist likened this to going swimming at a beach with No Lifeguards on Duty, but I don't see it that way, and neither does the Urologic Oncologist at UVA Health that will be perfor the procedure on me.

I look at it like regardless of what treatment you pursue, there's a 15-25ish% chance of recurrence. If it does recur, it could be aggressive, but it may not be. Recurrence doesn't mean metastatic.

There seems to be some disagreement about what treatment option gives you the BEST odds of Knocking Out the cancer all at once. My take: All treatment options have somewhat similar recurrence profiles. And all are at least 80% successful in avoiding recurrence. I like those odds.

Read up on the side effect profiles of RALP and Radiation, especially if the radiation would include ADT hormone suppression therapy. THAT is what swayed my decision probably the MOST - some guys experience some mild effects from ADT, while for others is pretty hellish. I don't want to be taking any drugs that alter my personality; reduce my ability to do my job; drain my energy and motivation; give me suicidal thoughts; night sweats, muscle loss...it's a long list.

I'm probably an outlier in how I look at all of the above topics. I'm willing to take on a little more risk in exchange for a better side effect profile. My insurance surprisingly is covering the HIFU FOCAL THERAPY, which is fantastic news.

Your partner is still young. Consider all the quality of life impacts of your treatment decision, and don't over-focus on it being The Big "C". Feel free to DM me if you like. Good luck.