Robo45vt, glad to see you are doing your homework on treatment options to make sure they align with your life expectations going forward. I am not sure how old you are, but age is a big factor. When I was diagnosed with PC in September 2022, I had a Gleason Score of 7 (4/3). I also did a lot of research and ultimately decided on a robotically assisted radical prostatectomy. For myself, I wanted a procedure that gave me the best possible chance for 30+ years of prostate cancer free life. There are a lot of statistic-based statements about long term survival rates and biochemical reoccurrence between the different treatment options. I am somewhat skeptical of these studies because the outcome is so reliant on variables outside of the studies control, or the analysis is skewed because of the base population that was included. Given my age and life expectations, I wanted a procedure that did not rely on imperfect imaging tools to guide the treatment, allowed for complete margin definition, and removed all known cancer from my body. Because my #1, #2, #3, ... goal was life, I was not as concerned with ED and incontinence. In the end, I have complete continence and erectile function, but these were not huge concerns for me - To be 100% honest, complete continence was a high want, but not an absolute need for me. Erectile function was obviously a want, but not something I was willing to prioritize over a prostate cancer free life.
From my experience and research - Your quality of life, for the rest of your life, will depend on the competence of your surgeon (RO, etc. if go with other treatment options) and support staff. You must do your homework and pick the best possible center of excellence available to you. Then, do the research to pick the best possible doctor at that center of excellence. I did not want the best manager (department head), writer, or instructor. For me, I wanted a surgeon that had performed thousands of robotic assisted radical prostatectomies, with excellent outcomes. I ended up going with Mayo-Rochester as my center of excellence. The hospital staff was amazing and my outcome is directly related to the quality of care I was given. If at all possible, please do not let distance be part of your decision-making process. Your life and the quality of your life will depend on the competence of the hospital and its staff. FYI - If financial means is an issue, there are options to work with Mayo-Rochester to get low-cost housing. This housing option was only available for certain conditions, and prostate cancer is one of them.

As always, the above comments are based on my experience. Everyone is different and you must choose the treatment plan that best aligns with your goals and life expectations.

Good luck to all,

Jim