I've been away for awhile, but my situation has changed, need input

So I was first diagnosed in late 2013, see my history below. It was only low volume gleason 6, and I was comfortable with active surveillance. Even my Dr., Dr. Roehrborn at UTSW was comfortable with that, and as a surgeon, AS is probably not his first instinct. I haven't even had a biopsy since February 2017, just PSA monitoring. Part of the reason for that was the last biopsy gave me an infection that put me in the hospital. However, PSA started inching up in 2020 and Dr wanted to do another MRI. The pandemic and procrastination put that off until Nov 2021. Recent PSA was 5.16. MRI showed that 7mm unconcerning lesion had grown was not a more concerning-looking 15 mm lesion. I don't have an appointment with Dr R. to discuss until next week, but I'm sure he'll at least want to do another biopsy. And just reading the MRI report it sounds like there's a good chance I have a higher gleason cancer and I'll finally have to get treatment. So I'm just thinking ahead and wondering what the options are now, 8 years later. Last time I was strongly considering TFT at the University of Colorado (w Drs. Crawford/Barkawi as an alternative to surgery. I really don't like the surgery option and will only do it if it is by far the best choice. Is TFT still around? Is it better than it was? Are there other options? Don't think I ever really considered radiation but can't remember why. Any other thoughts?

-Jason

Thanks, Mumbo. Yeah I'm probably jumping the gun until I get another biopsy to see exactly what the situation is. But I just wanted to see what the treatment options were these days so I could start looking into them. Thanks for the thought about the transperineal biopsy. Back in 2017 Dr. R said if ever did another biopsy they would do a swab for a culture first, I guess to see what caused the infection. But maybe they offer the transperineal now.