I'm happy to share with you how I ended up selecting surgery, but just know that I'm not suggesting anyone should do what I did. Rather, just the opposite.
Because I have 2 sisters who both died from breast cancer and my brother who had aggressive PCa 25 years ago, I (unfortunately) started this whole process with some strong feelings about how I wanted to proceed. With the giant caveat that I'm not suggesting anyone should do what I did, here's my story. Dr. Frendl (who I liked a lot) did my initial consult and did my biopsy, but he wasn't my surgeon. My surgeon was Dr. Paul Andrews at Mayo Phoenix. At the initial Mayo consult Dr. Frendl did recommend genetic testing, but I didn't pursue that. That was foolish on my part and I really don't remember why I declined except maybe I "just knew" I had bad genes (based on my sibling's history). I didn't realize that modern testing would also give insights into the treatment options. Unfortunately, I didn't let Dr. Frendl inform me of all that, but rather (according to my wife) I somewhat curtly cut off that whole discussion. So no genetic testing for me; my bad. Proceeding along, after the biopsy I was automatically scheduled to see a Mayo NP. She wanted to schedule me with both radiological and surgical consults so I could look at all options and decide on a course of treatment. My brother (based on his experience with both surgery and then radiation 25 years ago) strongly urged me to go the surgery route first. I took my brothers advice and told the NP that I only wanted to consult a surgeon. So without the benefit of any advanced genetic testing (such as a decipher test) to guide my decision making, and without letting Mayo tell me about other options, I pursued surgery. The "Mayo system" then assigned Dr. Andrews. I checked out his bio and liked what I saw, so I then met with him. I specifically asked if I was a good candidate for surgery and what my specific odds were for incontinence and ED. He told me I was a good candidate for surgery and told me he thought I had a 90% chance of being continent at 1 year and 70% chance of having sex at 1 year (assuming I could perform before surgery). Proceeding on, during the surgery consult Dr. Andrews' resident told me to start doing kegals before the surgery, which I did and I continue them to this day. I'm coming up on 10 months since the NS RARP surgery. I never was incontinent other than some stress incontinence the first few months. I did have ED, but (with the help of a Mayo prescribed daily program of 5 mg tadalafil) that's been improving and I'm now able to have intercourse with my wife (although not yet fully as good as before). The biopsy was 3+4=7 with what the surgeon called a "heavy load of cancer". The pathology after surgery confirmed that and also found both cribriform and IDC present. In hindsight, I should have listened to Dr. Frendl and gotten some genetic testing and followed Mayo's process and looked at all my options. But I didn't. I guess you can say I was "lucky" that the pathology showed I, just like my siblings, had aggressive PCa so surgery was definitely a reasonable treatment. Knowing what I know now, I'm very glad I went ahead and got the surgery. So while I have no regrets, I really should have taken a more scientific approach to evaluate my disease, let the care team at Mayo present all the options and their recommendation, and then selected the treatment option. That said, I'm confident Mayo wouldn't have done the surgery if they didn't feel it was an appropriate course of treatment. I think far and away the best decision I made was going to a NCI recognized CCOE. Bottom line, I have no regrets and I'm actually glad I had surgery. Other than some mild ED (which is slowly improving), I'm fully back to normal and enjoying life. So in spite of my failure to exploit the considerable talent and expertise available to me at Mayo, I still had a great experience and outcome. Best wishes.