Just to report back; I had my consultation with my Northwestern surgeon last week. In regards to my Decipher score, he said that my score would have no impact at all on his decision making of how much to take.

As far as the procedure, Dr. Perry takes the anterior fascia sparing approach with a conserved bladder neck. Meaning, that the bladder neck is spared and conserved rather than being removed or cut open. The approach preserves more of the structures around the prostate, which sounds like it helps immensely with continence recovery (and much lower occurence of inguinal hernias). However, the stats for ED look to be unchanged.

In Dr. Patrick Walsh's book (kinda considered a bible) "Guide to Surviving Prostate Cancer," co-author Dr. Schaeffer (who oversees the program at Northwestern) wrote the chapter on RP and describes the steps he takes in surgery on page. 205.
Started this technique in summer of 2021: Instead of removing fascia (connective tissue) surrounding the prostate (laterally and distantly, just past the apex). Then, release the prostate from the bladder. Then, nerve tissue sparing decision-which is based on what they find, plus MRI findings. If cancer is pushing out, then the nerves are more likely to be harder to peel off (like white veins on an orange) is nerve sparing is not as likely on that side. After that, the prostate is released from the surrounding fascia (connective tissue), this step helps to bolster the urethral sphincter…helping continence recovery. Next steps, cut urethra and reconnect…robotic approach allows preserving of the bladder neck rather than reconstructing.

Dr. Schaeffer even has videos of the surgery on Youtube, which I am absolutely not going to watch!

Thanks for all the helpful responses. Lots of things to worry about still, but Decipher and surgery isn't one of them.