I'm 58 and just starting on this journey. I had a regular checkup as part of the healthcare provided by my employer. Enlarged prostate and a PSA of 7 led to a meeting with a urologist who scheduled MRI ("equivocal") and then a biopsy.
The biopsy shows a small volume of cancer (1mm of 1 core out of 22 cores), with a Gleason score of 3+4.
I've since met an oncologist and surgeon. Both think radical prostatectomy is excessive at this point and consider either low dose brachytherapy or active surveillance as the preferred options, with the suggestion that the latter approach could allow for 5 or 10 years delay.
So now I'm just pausing for thought. I'm generally healthy and on no medications and until the diagnosis, cancer was definitely something that happened only to other people. So much for that.
I suspect I'll go with active surveillance for now, partly because it means avoiding side-effects for now but also because I'm an expert procrastinator.