Final countdown to RP on 3/26th and I’m anxious

Your position certainly isn't an enviable one given the effort and research you've put into arriving at your decision. I would ask the
NYU surgeon to articulate the upsides to surgery on the 26th and the downsides to a period of ADT prior to surgery with the potential to shrink the tumor, improve margins and add some degree of separation to the rectum. Wishing you all of the best in your reconciliation of these differing opinions!
Bill

I’m with those who say to shrink it with ADT if you can before surgery; proximity to the rectum - even with gel spacer and pre treatment ADT - makes radiation chancier for damage.
FWIW, with your Gleason Score, surgery is a sound first step - and with robotic magnification, surgery is much more precise. As jeffmarc said, this is not a sprint, but a lifelong marathon. Gotta keep your powder dry IF there’s a next phase and you need IMRT. Surgery first and then you just wait. Best on your decision,
Phil

I had an RP at age 68 for a G9 with no pre op evidence of spread. Later had oligo metastatic disease but was treatable with triple therapy and radiation. Now, almost 4 years post op my PSA is undetectable.

Of course, no one can definitively tell you if you are making the right decision but I believe you are certainly making an informed one. RP removes the high grade cancer immediately. It leaves the option for pelvic radiation open should you need it in the future.

The operation itself wasn't a big deal. A little post op discomfort for a day or two relieved with ibuprofen. I had a catheter in for 10 days. More an annoyance than painful. Put vasoline on catheter where it goes into the tip of the penis to avoid chafing.

Most men your age regain urinary continence pretty quickly. Erectile function as well. A book by Gagliani entitled Life After Prostatectomy (available on Amazon) helped me regain continence by following her instructions. It is pretty detailed if you like that sort of thing. If you don't start getting erections again soon after surgery you might ask your Urologist to put you on generic Cialis 5 mg/day to stimulate penile blood flow. Frequent use of a vacuum pump is helpful to some to keep the penile tissue stretched and healthy. Hopefully you won't need any of this.

Good luck!!

You'll do well. I had my RP at 60 yo using the Davinci system in August of 2022. No pain really after surgery. A little awkward with catheter for eight days. No pain on removal. No incontinence. I wore the incontinence underwear until I had my first post op visit. My Surgeon/Urologist asked me if I was leaking and since I wasn't told me to not wear them. If I was worried I could wear a pad which I did especially when I went back to work. I stopped wearing any incontinence pads after 3 months. I did go to a pelvic floor physical therapist for a few weeks to make sure I was doing my Kegels correctly. I started these 6 weeks after surgery. This was my first surgery and I was nervous beforehand but recovery and side effects have been minimal. ED is minimal, I am considering Viagra. So far my PSA tests have all been under 0.1. My doctor said I can get tested once a year now, but I am getting tested every 6 months. Best of luck with your surgery and try not to worry too much. You will be fine.

I did RP for Gleason 4+3 - surgery determined I was Gleason 9 with some spread into the bladder neck. I’m 4+ months after surgery and my post-op PSA is undetectable. I had some surprises with the aggressiveness of my cancer but I’m feeling fine today. I’m preparing myself for recurrence at some point. My biggest issue is incontinence and I’m doing physical therapy for that. .

I wish you the best. I’m hoping for a downgrade from G9 but we’ll see. I might have some incontinence issues given a wide excise. Again we’ll see. Good luck all around

I also had RP w/radiation in 2015. The RP was easy enough but the radiation was rough. Had a restriction in 2019 and 2022 that they tried balloon with a catheter but, then came back. In May 2024 I had Dr. Z at NYU do restriction surgery. He used a slice of my inner cheek to graft and replaced it with fish scales. Up until then, no incontinence. Since that day full incontinence. Dr. Z suggested ProAct to address the incontinence. My restriction came back now so, I sought a second NYU opinion with DR. M who suggested AUS.
So, now I have another restriction that has to be fixed and, full incontinence which has to be fixed.

WTF??? How many freakin times can you go thru this?
I’ve read that there are stents inserted in certain cases of BPH. Yours is more serious of course, but is there anything along those lines to keep the urethra open?

All the best to you . You have this brother ! I did a RP about 4 years ago now . PSA is very low and bounces around 0.036 - 0.058 . I also had External Bean radiation about 1.5 years ago , 22 sessions - no ADT , as PSA creeped up to 0.14 , so go radiation at this point . Feeling fine , PSA is usually very low and living life normally . Bladder and ED was a minor problem at first , now its fine ! God Bless from Vancouver Island . James

@vancouverislandhiker thank you for your comments.. yes. I got this ! I’m glad you are doing well. I’ll keep you posted.. appreciate all the support on this site. It’s actually been very reassuring.. bless you all ! 🙏💪