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Terry,
You didn't mention that the treatments and the side effects are getting better every year. The longer you can wait to get treated the better the treatment will be. If your life expectancy is 15 years with a GS of 6 then you can afford to wait to see what treatment will be available in 10 years when you might decide to get treated. By then the treatment may be a vaccine with none of the traditional side effects that reduce ones quality of life.
If you are a GS 4 & 3 or above then you don't really have much of a waiting option.
How will your thesis change if there is a therapy for T1-T2a, with localized cancer, that can be identified in a high likelihood using MRI and template guided biopsy and can be focally ablated resulting in close to 0% morbidities? I qualified to this HIFU Hemiablation procedure and have a stable PSA for almost 24 months with minor side effects.
I have changed the title of this post back to the original to make it clear, yet again, that I am NOT giving advice in this post, or suggesting that anyone should do what I do, or advancing a thesis. I am merely responding to a question asking why I chose my path and not surgery.
Of course if there was a guaranteed cure that is to say a therapy that would result in a complete remission of the disease for the rest of the man's life with no side effects at all, there would be no need to consider active surveillance, but there is no such therapy available at present.
Focal therapies are in their early stages with no long term data. You say at 24 months, a couple of steps along the marathon that is prostate cancer, you have a stable PSA with minor side effects. At 24 months, my PSA had reduced from 7.20 ng/ml to 4.35 ng/ml with a 42% free PSA and I had no side effects at all. Check out STEVE Z who also chose focal therapy before making statements implying that this therapy is a sure cure.
All the best as you travel your road and I travel mine.
