Age 53 with stage 2 cystocele. why would my urogyn offer only pt and estrace cream as a solution?

Good plan: I would concur with your doctor, as this is a good starting point, and may be sufficient to regain control of the problem. If is is not better, with these treatments, this will have improved the health of the pelvic tissues, and possibly improve chances that surgery could be successful. This would still needed after surgery as well.

Cystocele: These are the best methods of treatment at this stage. I think you have a very conservative OBGyn as most of them would probably suggest surgery instead of giving you a chance with conservative therapy