Newly Diagnosed: Removal vs Radiation

Removal or radiation are not your only options. I am a bit older, but I chose Tulsa Pro because the risk of side effects were so low. I am three months out and my PSA went from 8.6 to 0.68. I have extensive follow up which gives me peace of mind, but what really sold me is the fact that all other options are still on the table if I need further treatment. my story at the attached link.
https://connect.mayoclinic.org/discussion/tulsa-pro-experience-mayo-clinic-mn-july-2024/

You are totally correct - the nightmare never goes away but it dies become less and less scary over time.
I too, opted for surgery (grudgingly!) because my pessimistic nature ‘knew’ it would come back ….and 5 yrs later it did.
Literally just finished 25 tx radiation at Sloan and have 2 more months on ADT. It was NOT the end of the world! You just say, “OK, let’s do this!” And you do it.
I also met many men going for Cyberknife therapy and if you are a candidate, its 15 yr success rate is on a par with
Surgery. Another newer modality is high intensity brachytherapy - (seeds for like an hour or so) followed by 5 cyberknife treatments.
The big question is what to do if it returns and that subject will get you many, many different opinions and answers….best of luck!

On a positive note, I do personally know 2 guys who had NS RARP, one 14 years ago and the other about 8 years ago. Both are continent, sexually active, and neither has had the PCa come back. So there are good stories out there, but as you said I suspect most of those guys just move on and put it behind them. I had NS RARP in late June 2024 so it's too early to tell for me. But before surgery my surgeon at Mayo Phoenix said that for my specific case 3+4=7, T2a, 11 of 19 cores containing cancer, I had a 90% chance of being continent at 1 year and 70% of sexual recovery. Frankly, those were better odds than I expected, and at 5 months I am 100% continent and am able to have intercourse with my wife (albeit much less good than before but slowly improving). After surgery at the 3 month visit the Mayo urologist said based on my clean margins, no extension, no gland involvement, I had about a 95% chance of being cancer free at 5 years. The following Sloan Memorial data base gives me a 91% chance of being cancer free at 5 years and 82% chance at 10 years. So I think there are positive stories out there, but as you said I think they don't tend to frequent this blog. Here's the link to the Sloan Memorial database:
https://www.mskcc.org/nomograms/prostate/post_op
BTW, this is just the data I happen to be familiar with. I'm not suggesting that RARP is the "best" treatment or that's it's what you should do. I have no idea what's the best treatment for you. Rather, I just wanted to share some positive data with you to respond to your post. As an aside, I don't know but I believe the quality of care (ie. going to a cancer center of excellence if possible) is more important to one's outcome rather the specific treatment selected. I'm not a medical professional but that's my 2 bit opinion.

Thanks for that, it does help a. bit. The link I was given from one of my consults and I've seen that many times (all docs seem to like to use that to show you the prognosis).

RARP is the best choice for me, if I am to believe what experts have told me, and that is what I'm going with in 6 weeks.

RARP may indeed be the best choice for you. But if you haven't consulted a radiation oncologist favor yourself with that consultation.

I did three of each: urologist, radiation oncologist, medical oncologist. All concur that RARP is best for me at my age.

As you know, there is not "one way" or "best choice". It all depends on you. The fear of radiation is somewhat reduced these days. The 3+4 vs 4+3 is a big deal, even though both equal 7. That difference can be a factor. I've been advised that the "no surgery after radiation" rule no longer holds. I had HDR brachy a couple years ago but many of the new beam technologies look promising (with their ability to stop and start exposure). Still, at a young age, the 20-year potential issue with radiation exposure can still exists. If you currently have difficulty with flow that might rule out radiation. The current charts say that HDR radiation still gives slightly better long-term results but both are considered gold standard. https://www.prostatecancerfree.org/compare-prostate-cancer-treatments-intermediate-risk/ Best of luck with your decision. You probably can't go wrong with either choice. You can very likely end the cancer threat, but you are NOT making your body better. Of course, as the years pass, time is not making your body any better either. For me, it came down to a choice of which downsides I would prefer to live with. I said no to incontinence and ED. I said yes to possible future radiation cancer with the hope that a true "cure" for all kinds of cancers might be developed in 20 years.

I will have my PSMA Pet Scan this Friday, at the Charlton Building, Mayo Clinic. I have been waiting since November 5th, when I discussed possible participation in a study comparing outcomes between Tulsa Pro Ultrasound Ablation and Radical Prostatectomy. Of every three participants, two will get Tulsa Pro, and the other will get prostate removal. Providing I qualify, after the PET-CT Scan, a computer will select me for one treatment or the other. I also have a radiation consultation on January 2nd. I was diagnosed with prostate cancer on October 11, 2024. They found five lesions: a 6mm Gleason 7 4+3 with 20% core sample cancerous, a smaller Gleason 7 3+4 with 25% core sample cancerous, and three smaller Gleason 6 3+3's with 15% or less cancer in the cores. They took 20 cores altogether, 5 with cancer, one with abnormal cells, and 14 with benign prostatic tissue.My last PSA was 5.8. My last DRE was smooth with no nodules. My Telsa 3 MRI showed no suspicious lesions in the pelvis, bones, or lymph nodes. Since diagnosis, and during the wait for my PSMA PET Scan, I haver poured over many Youtube Videos on Prostate Cancer, and treatments. It is reassuring that my cancer will likely be cured, but, I feel pretty down about what treatment will do to me. I wish I could just do active surveillance, but my doctor does not recommend that because of my 4+3. I wish there was someway to stop the cancer from growing and spreading, by diet and exercise. After reading an NIH study that showed a link between eating 2.5 eggs a week or more and a 81% increaded risk of LETHAL prostate cancer, I have quit eating eggs ( since October.) I have quit eating all red and processed meats, all dairy, and an now on a mostly plant based diet. Since prostate cancer usually grows slowly, I am wondering if I can slow it down further, or stop it altogether by my diet? This may all be a waste of time, and it has been pretty depressing. I am not ready to give up my sex life and not ready to have chronic urinary incontinence. I am hopeful that treatmet at the Mayo Clinic will improve my chances of avoiding permanent or severe side effects. I am 68 years old, in good physical shape, and sexually active with no problems. Is there reason for hope with all of this? Have some of you done well with treatment? Anyway, thank you for reading all of this...

Best of luck. I was sexually active 1 week after Tulsa and never had any incontinence.

Interesting @mspotter, thanks for posting. After reading jcf58, I hope you get the Tulsa.