Center of Excellence questions/recommendations for CA resident

Greg, you should call the financial offices at the hospitals to find pricing. Insurance especially Medicare controls the cost to the patient. Consequently, the cash pricing can be ridiculously high. You may be able to negotiate, but even for a consult it can be unaffordable. Mayo didn't have my insurance information and I received a bill for over $1,900 just to look at my records. The doctors consultation bill came in at over $700. And that was after I was told they offered a procedure that they don't have working equipment to perform.
UCLA offers support for the under insured. I'd recommend UCLA over UCSF. They have one of the best, cutting edge prostate cancer centers.
https://www.uclahealth.org/patient-resources/patient-financial-assistance-program#:~:text=UCLA%20Health%20is%20committed%20to,%2C%20uninsured%20or%20under%2Dinsured.
Best wishes

Ava11,
CA Proton is on a different information storage system, so it takes longer for them to retrieve information than from medical institutions on a common server. USC is in the same situation with yet another storage system. Even so, seven days is long. CA Proton is one of maybe 48 Proton centers in the US. And Rossi has an international reputation, so patients come from all over the world. Consequently, they are busier than other cancer centers. You may also have a wait for treatment.
I'd keep calling though. If you decide to make the drive, you might schedule it for the day they are having a tour. It is really interesting equipment. Otherwise, consider a phone consult. Rossi has an easygoing charm.
Because you are having the 28 anyway without MRI guidance, proton may have an advantage over photon for side effect.
Do you know your total Gy at Lennar. I hadn't heard of brachytherapy and IMRT together. Did Lee give you a good idea of the advantage.

I'm the OP for this thread and still hoping that others may chime in on the original question. Thanks to all that did give their input but the thread was unfortunately hijacked by multiple other poster's questions and I'm having to sift through them to see which are for me. It seems there are more replies about other's unrelated questions than my original post?
But again, thanks to all that stayed on topic and provided their input/advice.
I met with the radiology oncologist last week so I am now in the process of making a decision (surgery vs EBRT, who, and where).

greg52: ask about the radiation machine's margin exposure especially if you are worried about side effects. You have choices. 2 mm margins vs 3-5 mm margins can make a difference in your side effects and quality of life Mridian and Elekta are two machines with built in MRI and narrow margins. If they were not mentioned by your doctor, then they are showing a bias that may or may not be best for your needs.
These machines are available in California as I have seen comments about places to go who have them. Also, many patients can have 5 hypo fractional treatments as my brother and I did, in NY city and Orlando Fl. Get second opinions where you can and DON'T accept one answer as the end all and be all of what ONE doctor on the subject of radiation says. Use telehealth consultation sending your test results into the doctor for your convenience.
PM me if you want any more information on my consultation sources and my research.

In the SF Bay Area, the best recognized is UCSF. You can receive both surgery and radiation oncology recommendations at that facility. Others listed are: https://www.pcf.org/patient-resources/patient-navigation/treatment-centers/. They accept most insurances. 1k’s of robotic surgeries performed, but ensure that the surgeon you select has an excellent track record of results in terms of continence and ED.

Thank you so much for taking the time to provide your input/experience. I had met with the surgeon in my health network a few weeks back and just met with the Radiology Oncologist yesterday (4/25/2024).
The Radiology Oncologist was a lot more helpful than the surgeon that would be performing the RP. Just a lot more info about the different treatments. Spent a lot more time with me. His main message was that (as many here have said) both forms of treatment are effective and that it's really about what makes the most sense for me.
He said PSA 8.6 (now 9.6), Gleason 7, Stage 2 are the numbers I need to focus on. And the fact that more than 50% of my biopsy samples showed cancer (3+3, 3+4).
Those are the things that dictate his course of action/treatment recommendations. He said that because I am kind of "in the middle" as far as age, radiation OR surgery are both good options.
I was leaning toward RP before I met with him but now I'm not so sure. His area of expertise EBRT and that is the treatment I would get if I opt for radiation treatment with my current provider.
He said incontinence/impotence likelihood for surgery is also higher than radiation (50% to 33% respectively)?
He said he, in my position, would not have a problem having the surgeon in my network perform the surgery if I chose that.
He also said there can be benefits to going to a Center of Excellence for treatment but in many/most cases, the added travel, cost, and trouble just don't justify it unless you live somewhere where treatment quality/cost, or the experience level of your docs/surgeons (or lack thereof) warrants it.
He said the peace of mind of getting the best care available to you regardless of cost may be the biggest benefit and not trivial if it brings you peace and gives you confidence to move forward.
So more info to digest from yesterday to help with my decision.
Hoping others will chime in based on this latest info.

Thanks all.

Most importantly, I wish you the best of success in whatever treatment and wherever you choose to have that treatment.

In my opinion, there is a higher probability of getting a highly skilled RO or surgeon, and their team, along with more recent generation equipment in a center of excellence prostate cancer treatment center. However, they are "state-of-the-art" radiation treatment centers that are not located within a recognized "Prostate Cancer Center of Excellence." As outlined by @bens1, you want to ensure that if you choose radiation therapy, the RO is using the best available equipment. It makes a difference in both the treatment success rate and your quality of life in both the short-term and long-term.

If you and your doctors believe that all of the PC cells are contained within your prostate and you choose RP treatment, you want a surgeon that has done 1,000+ operations with a track record of success (statistics on patient continence and ED) and is using the latest generation/upgrades of the DaVinci robotic equipment. Any treatment center can buy DaVinci robotic equipment, but not all surgeons operate that equipment with the same level of skill and not all surgeons use the same technique for a prostatectomy. The highest success RP techniques, in terms of continence and ED, require an experienced surgeon with a high level of skill.

Not all doctors can provide the data available, but it starts the conversation on their demonstrated level of expertise.