Diagnosed May 9th 2018. Lots of good information and people here. Been following this group since May, but haven't posted anything until today. Here are my numbers.
PSA 4.0 at biopsy. Positive DRE
Standard 12 core biopsy. Three different pathology reads at three institutions. These numbers are from Dr. Epstein @ John Hopkins.
3 on left side Gleason 6 and 1 3+4
2 on right side Gleason 6
7/10/2018 - mpMRI - 2 lesions on right. PIRADS 4, 3. 2 lesions on left PIRADS 3,4
Large field-of-view images demonstrate multiple enlarged bilateral external iliac chain lymph nodes. No suspicious bone
lesions.
7/19/2018 - Second opinion on options.
7/23/2018 Oncotpe DX - 37
Written by
bw1963
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This started 2 years ago with my primary care doctor sent me to a urologist for PSA velocity. Urologist offered a biopsy then (PSA 3.57). Ask to wait if he thought that was ok. He was fine with waiting a while and check again. DRE and PSA every three to four month until May of this year when DRE was positive. PSA fluctuated over this time, but 5.0 was the highest and 2.84 was lowest.
To my inexpert mind, you have two markers (PSA value, PSA velocity) that suggest that no treatment is needed at this time and four markers (positive DRE, one Gleason 7 biopsy sample, more than 2 or 3 of 12 biopsy samples with evidence of cancer, and age 54) that suggest that treatment, while not urgent, is worth getting.
I include age here because, assuming no other major health issues, you have many years of life ahead of you - time enough for your prostate cancer to become high risk. If and when the cancer escapes the prostate itself, the chances of successful treatment decline significantly. So if you know you will need treatment in the future, it may be better to get it now while the chance of metastatic disease is lowest.
On the other hand, it's also conceivable that ten years from now treatments will have improved and something simpler, less invasive, and more effective might be available.
I don't know what you should do. I think if I were in your shoes I would start researching all of the standard options - surgery and the various kinds of radiation. Equally important, I'd research the best doctors and hospitals to find someone who is a top specialist in prostate cancer treatment in whatever part of the country I lived in or could easily reach. If I were inclined towards Active Surveillance (which I probably wouldn't be in your shoes), I'd meet with the best doctor I found and work up a plan both for how often I'd get PSA tests and MRI and/or biopsies, and decide on the criteria that would signal me that it is time to take action. I've often seen people plan to "wait and see", but without any plan for exactly what they see that will trigger a decision to get treatment. For example, you might plan that if the PSA reaches 10 or the number of positive biopsy cores increase, or whatever, your AS is over and you will put your treatment plans into action.
After long research on this disease, I have decided to have the surgery. Open technique with an extremely gifted surgeon that does around 120 a year and has done well over 2K of them.
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I’m new: Dr. recommends Prostatectomy: I’m 59
New to the prostate cancer community
Here we go.......
newly diagnosed Gleason 7 3+4 
Followup on friend I mentioned. 
