Diagnosed Yesterday 04/14/26 - Gleason 9 treatment

Your situation is a lot like mine. I had a test after returning to the U.S. that found high PSA. After the MRI, PET Scan, and biopsy, it was a Gleason 10 (later post-surgery pathology downgraded to 9 with cribriform), and PIRAD 5. After much research and discussions with docs and my wife, I chose non-nerve sparing RARP in Oct 2025 due to the cancer locations, severity, high risk of return, and treatment options should cancer reoccur. Surgery turned out well with clean margins and no spread, but I do have light incontinence, which has seen improvement, and ED. Both I expected and we working through. I am happy with the decision. This forum has helped immensely. Your way forward might be different, but whatever you choose will be well researched and what you decide will be the right option for you and yours. Best.

Hi , I just got my RARP done in Germany at the Martini Klinik in Hamburg, 3 weeks ago. DaVinci, 6 port.
The reason i went to them is that all the other clinics mentioned that they will not do any nerve sparring.
They utilize the neurofreeze technique where they freeze your nerves and do slicing of the prostate while you are still on the surgery table.
In my case i went in thinking that I will loose completely the left nerve bundle.
Coming out out of the surgery, the surgeon tells me that they only removed 20% of the nerves on the left side and 10 percent from the right side. So i still have 70% of the original nerve bundles.
And penis shrinkage is not really visible.
Depending on what it will will cost you to get the surgery in the States, you may want to look at the Martini Klinik as plan B.

Stay strong and be positive.
Dinu

@byelliq6 Since you’re already so far west, a center of excellence in California would make sense; they can certainly do telemedicine visits before treatment.
Jeff Marchi probably can give you some excellent doctors since he lives in California.
While your Gleason score is scary - sorry, but mine was a 7 unfavorable and I almost dropped dead - there’s no reason an excellent surgeon can’t get it all.
You are being pragmatic about micro metastases which is why surgery is ideal. Get out the tumor and then follow up with salvage treatment if necessary - or adjunctive treatment immediately post-op depending on the surgical pathology. If margins not clean or capsule is broken you’d probably want to be more aggressive with treatment. Best of Luck,
Phil

Biopsy slides can be viewed with artificial intelligence. ARTERRA compares your slides with thousands of others and may help in the guidance process.

If you come down to California for treatment here are some real good doctors. I am not sure you can get remote consulting with them, but you can try by calling them.

UCSF
G U Oncologists you need to have Metastasis outside of the prostate to get treatment from them
Eric Small not real friendly
Rahul Aggarwal
Terry Friedlander
The two other types of doctors you may need
Urologist Peter R. Carroll
Dr. Mack Roach Radiology

UCLA
Dr. Matthew Rettig GU Oncologist

Hutch in Washington state
Schweitzer
Fong

OHSU Portland Oregon
Dr. Eleni Efstathiou GU Oncologist you would have a hard time going to a better doctor than she is

Dr Jeffrey Bassett
Surgical
Hoag Hospital
Newport Beach
Up to date latest surgical techniques

@davederousseau
Dave, Thank you for sharing this information it was helpful. I too am leaning towards an aggressive surgery approach with if necessary, follow up salvage rational and ADT. I am amazed at the knowledge and wisdom being transferred daily on this board with its dedicated and well informed members, it has save me unfathomable time in my research efforts over the last week.

Thank you

@thmssllvn
Thank you! I did speak to my RO last night and he sent the biopsy slides yesterday to ARTERA for the ArteraAI Prostate Test report. He tends to find this the most useful tool for the long term game plan.

Additionally, my UO sent the Slides to Decipher yesterday. So with those two genomic workups I am hoping to have a better picture of the suitability of Surgery or Radiation.. I believe once I get these two reports I will make the decision. Regards,

@jeffmarc
Jeff,
Thank you for the list.

I am leaning towards California, UCSF was not very receptive to a remote/telemedicine call and they wanted to schedule me about 7 weeks out for a consult, which was vague. They have a written second opinion program run by Summus it's $900 but you are not guaranteed the doctor of your choice and you don't get to speak with anyone. They review the MRI, PET, Biopsy and notes and give their opinion. I believe discussion options with an expert is of great importance so I going to pass.

I will be reaching out to others today.

Many thanks,

@dinu
Very interesting, I reviewed the Martini Klinik website, extremely professional, high volume state of the art. You chose well.

I will keep it in mind.