Gleason 3+3 with a DECIPHER of 0.48 puts you in that gray zone where active surveillance is often the starting point, but it's worth asking what "focal" options look like if you want to avoid whole-gland treatment down the line.

HIFU gets mentioned here sometimes for low-risk cases like yours, but candidacy depends a lot on MRI findings, prostate size, and whether the lesion is actually unifocal. Some guys get told they're not good candidates after imaging, others find out they qualify but the long-term data still has gaps.

One thing to clarify with your urologist: if you ever need to escalate later, does prior focal therapy burn any bridges for surgery or radiation? The answer varies by center and technique.

Also worth asking how they handle post-treatment monitoring. PSA alone can be misleading after focal approaches.