jtmarti1 - Sorry to hear you have been diagnosed with prostate cancer at such a young age. I was also relatively "young", being diagnosed and treated at 56 (Gleason Score 4/3). Being on the younger side of the curve, I opted for the most aggressive path forward (radical prostatectomy - Mayo Rochester) to give me the best possible chance of living prostate cancer free for 30+ years. I evaluated all the treatment options, but with my #1/#2/#3/... goals for treatment being 30+ years of cancer free life, I kept coming back to complete removal of the prostate, seminal vesicles, and surrounding lymph nodes (not all, but 9 taken for evaluation). I had a high desire for continence and a want for erectile function, but these were not an absolute necessity. In the end, I am 1.25 years post surgery, PSA is undetectable so far, and have full continence & erectile function. I attribute these good results to taking the time to choose the best possible center of excellence, picking the best surgeon at the center of excellence, doing all the optional/required pre/post surgery therapy, keeping a positive attitude about life, and of course praying.

I could not justify active surveillance because I just could not get past letting known cancer continue to grow within my body, knowing that it will at some point need to be addressed, and potentially metastasize outside the prostate. Cancer is tricky and no doctor can tell you with 100% confidence that the cancer will not spread. Also, imaging tools and physical biopsies have come a long way, but are not perfect - I was unwilling to bet my life on these imperfect tools & procedures.

Another reason I went with a RP was the ability to perform a post surgery pathology and define physically the margins. This gave me more confidence and peace of mind going forward.

I also evaluated radiation therapy, but did not want to rely on imaging tools to guide the treatment and I did not feel comfortable with the long term impacts from the radiation.

However, surgery does NOT guarantee the cancer will be gone forever. I have a 20% chance of bio-chemical reoccurrence and pray every day that the prostate cancer does not come back. Please note, nobody can tell you want the best treatment is for your unique situation. If someone tells you there is only one path forward, I would kindly ignore their advice ): . You must make that call yourself, then move forward with the consequences. I always recommend an honest evaluation of your life goals and then picking a treatment option that best aligns with those goals.

Best of luck with your decision and pray all goes well!!

Jim