Unfortunately, some aspects of prostate surgery do not have a 100% black and white guidelines and depend on the urlogist's risk assessment, experiece etc. And some urologists may not keep up with all the new guidliness or may be negligent. In my own experience one of the urlogists I consulted for second opinion decided I should be on active surveillance even before my pathology report was re-read, and while the GPS test score was pending!! He said that even if the new re-read of the pathology comes out to be 4+3 instead of 3+4, I should be on active surveillance! I am not a urologist, but what this doctor told me is 100% BS (a new medical term :)) ! It does not align at all with the NCCN guideline on treatiment for unfavorable intermediate risk patients. I never saw that dude again!!