Everyone will have their own experience and recommendation, but I highly recommend the DaVinci Robotic- Assisted Radical Prostatectomy. Your urologist/surgeon, having done 4,000 "+" DaVinci RP's plus your younger age give you your best potential outcomes in my opinion. Your "youth" will yield a more rapid and easier recovery vs someone like me at age 70 (and those older). The one big falsehood, is that the biopsy and Gleason Score tell you how aggressive your cancer is. "Nope." Unless of course your Gleason score is an 8 or 9...then you know you have a problem, and can likely expect worse news in your surgical pathology report after your RP.
"Symptoms"? Unless you're a man with moderate to severe urinary flow restriction due to an enlarged prostate, most men do not have symptoms of prostate cancer. It is "caught" upon routine PSA and DRE with your Internist or General/Family Practitioner. My brief story:
My former physician abandoned his patients and practice without telling us...flat-out closed down and moved away with no letter or other notification. "Foolish me" went four years without a routine doctor appointment or annual PSA tests. I finally decided that I need a new doctor. Because I was a "new patient", I couldn't get an appointment for 9 months from first inquiry...NINE MONTHS. That certainly didn't help me. During that nine month wait, my Gleason score probably became what it was. So my progression thereafter was:
- October 2024 - PSA 6.5 ng/ml
- November 2024 - referral to Urologist with repeat PSA of 6.1 ng/ml
- December 2024 - 12-core biopsy
- Early January 2025 - Biopsy results: Gleason Score 3+4 = 7 with only 6-10% "4" grade cells. I was very close to being just a 3 + 3 = 6, but was definitely not. I also had perineural invasion which my doctor said everyone has. My physician said: "It is great that we caught it early...you'll be around ("alive") 15 years or more from now."
- April 2025 - DaVinci Robotic-Assisted Radial Prostatectomy.
- April 2025 - Surgical pathology report yielded more ominous results: Extra-prostatic Extension ("EPE"); Cribriform glands; "Surgical margins"; Left seminal vesicle invasion. NONE of that can be determined from a biopsy, not matter how many cores they take and what your Gleason Score is. "Surgical Margins" are basically surgical bad luck...incompetence...when the surgeon left some cancerous tissue behind in your body: (S)he didn't "get it all." That only happens 10-20% of the time, so being thrown into that reality, I am quite disillusioned with my urologist.
- April 2025 - Based on the above microscopic/cellular results, I am therefore a pT3b classification, and therefore, with a near-certainty that my cancer will come back within the next five years. It could be less than a year from now, or it could take five years, but it is nearly certain that it will return. The nature of a pT3b is because it entered the seminal vesicle(s), and even though both seminal vesicles were removed along with the two vas deferens, just somehow it always "comes back."
At biopsy when my physician was very confident about "we caught it early", he still said: "I'm taking your prostate...there is no use doing "active surveillance"...YOU HAVE PROSTATE CANCER, and there is no point watching and waiting for months and up to two years...it will only get worse, it is not going to spontaneously disappear."
July 2025 - I am doing PSA tests every three months for the first year post-RP, hoping they will stay at < 0.1 ng/ml, but...the moment it increases 100% to 0.2 ng/ml or more, my Urologist said "we'll need to talk about radiation." If you haven't heard (I was shocked), "radiation" is a 40-consecutive-day ordeal. Your life changes for those 40 days, because every single day of those 40 days, you will go to radiation therapy to get zapped. The downside of that, is that a low percentage of men end up with bladder cancer or rectal cancer or permanent incontinence, and a sex life that is dead and over...just exchanging one horrible reality for one, two, or more worse realities. The only good news about that is that I am 70 years old, and while I could perform well right up to my surgery, I am newly divorced, and there aren't a lot of 60-75 year old women who want too-active of a sex life. They're kind of over it at that age from what I have heard through friends and former coworkers. So again...my recommendation is to get the DaVinci RP done. You should have a nice outcome at your younger age.