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Take a deep breath. With the characteristics you describe, I personally would probably opt for RT not surgery. The adjuvant RT post-surgery will compound side effects. Urologists will probably argue that you need to get rid of the mothership, but modern RT has similar long-term survival odds to the proposed trifecta.
Intraductal is different from cribriform. There is apparently some evidence that the latter is not as responsive to RT, but I have never heard that of intraductal.
Definitely do a Decipher and a PSMA. The first will give you information about the cancer’s aggressiveness (risk to metastasize), the second will show if it has already spread. The fact that your current urologist did not order these and directly rushes to RARP would be a red flag for me.
Definitely make an appointment with a radiologist at a center of excellence. While you are at it, also get an appointment with a medical oncologist there and also a second opinion from urologist. Tell them
that the cancer is aggressive to get a quicker appointment. One more month or two before treatment is not going to make much of a difference.
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Thank you for your response. I mentioned the decipher to the radiologist, but it wasn’t addressed. Is that an analysis of the biopsy? He did have the PSMA which showed no metastasis. Our health insurance is Kaiser of Northern California. They will not refer out for a 2nd opinion to a center of excellence. The Surgeon we saw is a Surgical Urologist Oncologist. My husband made the decision to have it out vs radiation and the surgeon said that it is easier to do salvage radiation after the surgery then it is to do surgery after radiation as there will be scar tissue to remove from radiation.
Would a decipher give us any additional useful information? The intraductal on its own is what has tipped this to be considered aggressive. Also, in hindsight I wish things had moved quicker because of the sheer volume of positive cores.