I have had pretty much all the same symptoms as you in terms of golf ball and cramping occasionally when bowel full. Originally detected something was wrong based on blood in semen. GP initially ruled out anything to be concerned about. My GP watched things for the next few months and in March 2016 has a PSA which came back as 4.29. Had two further PSA’s which came in at 3.9 and 4.12. After the third he said he is obliged to refer me to a urology consultant which we did. Engaged Sept 2016 and went through cystoscopy, ultrasounds, DRE, urine tests etc and all came back normal aside from that good ball sensation that had been there from nearly start of symptoms. Was assumed to be prostatitis so went on a course of antibiotics for 3 months but not fundamental change to PSA following this. Did three monthly PSA and they all hovered around 3.9 - 4.5 still. In November 2017 it was decided to have an mpMRI which was done on a 1.5T based system. This was done Jan 18 and came back PiRADS 2 so I was given a preliminary all clear with the advisory to have PSA done again in six months. Being a bloke I assumed all was probably ok and left it 18months before having bloods again 🤔🥴 So July 2019 PSA came back slightly elevated at 5.6. Urologist suggested an MRI. Fortunately a new system had become available using 3T. Results came back from this July 19 as PiRADS so we knew something was up.
Next steps were TPM targeted biopsy under General anaesthetic. Result from this came back mid sept at Gleason (3+3)=6 5/20 cores showed adenocarcinoma low grade with max size 5mm. Unfortunately in all four quadrants and one near the capsule. London MDT met up a month later (Oct 2019) and echos the advice of AS.
In the interim I had done a lot of research and also reached out here plus checked others experiences and timelines. Also reached out locally to groups. I’m fortunate in a way as I understand quite a lot about the pathology of cancer and stages etc due to my ex being a researcher in trials in this field.
From this group I became aware of a relatively new surgical technique (Retzius sparing) which evolved ~2017. Plus the names of Prof whocannotbenamedhere and a few others in London. They use robotic surgery but go in under the bladder which has shown it had dramatic benefits in terms of preserving urinary continence. Plus they use an additional process called neurosafe which essentially means a pathologist checkers out tissue samples in real time during surgery with the aim of a more informed surgical margin (negative margin) if the tumour is still within the prostate capsule.
I think neurosafe allows for more precise surgical margin if nerve sparing with the neuro vascular bundle is possible.
For me at the age of 52 I didn’t fancy the prospect of ongoing scans and biopsies plus risking the cancer changing. Or indeed if a higher grade existed undetected if that came into play. I was reassured this was unlikely and without establishing a ‘doubling time’ thus far it could be safe to leave for months/years/decades.
With it being multifocal it kinda of ruled out RT(too young) Hifu, nanoknife, cryo, phototherapy etc. Only option for me given my age was to have it out with Retzius sparing robotic assisted technique with a high volume surgeon with excellent stats. Risks are with any operation and general anaesthetic plus some chance of continence issue and depending on nerve sparing that’s possible some issue with erections going forward.
If the histology echos the biopsy surgery could be curative obviously with caveats that it’s still a metastatic disease although unlikely to migrate at this stage.
Obviously the procedure leaves you sterile. I did look at sperm freezing but decided this wasn’t needed as if I do decide to have kids down the line at some point there are fairly new options for direct sperm extraction from the testicles although at 52 I’ve probably missed the kids windows if I’m honest.
i would say that there isn’t any right answer. It’s what is right for you and works best given where you are in life etc There are caveats with any of the choices really. For me I went away and learnt as much and I could and talked to various people so that my mixing pot for full of evidence based facts and then decided where I wanted to go from there.
I’m scheduled in next week so will post a new thread detailing the journey.
Good luck with your journey and shout if you have any questions or need a view etc