Diagnosed today w/ PCa. Seeking feedback w/ treatment I think I want

@colleenyoung

I’m doing great first post RALP PSA less than 0.006.
No further treatment scheduled at this time. I thank God, my family and my doctors. Thank all at Mackinac for their support and concern.

I would remove the cancerous tissue as a first treatment then down the road if there is still some cancer kill the rest with radiation. The more treatment options you have will enhance your chances for long term survival from this disease. Above all hand it all over to God.

I have a Gleason 4/4 and have been around the horn and back reviewing my options. Your urologist is doing what most urologists do by downgrading and misrepresenting or flat out ignoring the published studies comparing radiation vs surgery. Please review Dr. Marc Scholz's videos on Surgery vs Radiation and the other videos on the subject on the prostate cancer research institute site.
If performed at a center of excellence, your cure rate is dramatically improved and side effects are far fewer than with radical prostectomy. ALSO, the guidelines for duration of ADT have been reduced depending on your profile ( which as I read applies to you ) and that is discussed as well in several videos. A high risk Gleason , at the top centers is now at 4 to 6 months Orgovyx vs 12 to 18 months, which some stone age centers continue to recommend. You must consult with radiation oncologists at the top centers. UCLA's Prof Albert Chang and Zelesky at NYC Langone are at the top of the game. But first, review the videos referenced above. Another clarifying video is by Prof Mira Keyes " Brachytherapy, the Royal Flush of Prostate ...." I'm happy to expand on the above after you have reviewed the above videos. Thanks

@carl123
I disagree most urologists don’t downgrade, misrepresent or ignore studies. Certainly radiation is substantially improving as well as studies reflecting how long ADT can necessarily be needed . It is hard for anyone to stay on top of things, and that is why patients do need Centers of Excellence. Just as studies show the improvement in surgery.
Studies consistently show that Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) is superior to standard anterior robot-assisted radical prostatectomy (S-RARP) regarding faster recovery of early urinary continence and improved, sometimes faster, return to erectile function. RS-RARP preserves key anterior anatomical structures, which improves functional outcomes while achieving comparable cancer control (oncological outcomes).

PubMed Central (PMC) (.gov)
PubMed Central (PMC) (.gov)
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Key Findings on RS-RARP Superiority
Faster Continence Recovery: RS-RARP patients demonstrate significantly higher early continence rates (at 1 week, 1 month, and 3 months) compared to standard RARP, with some studies finding it reduces time to continence by over 80 days.
Improved Sexual Function: Multiple studies and meta-analyses suggest improved preservation of erectile function compared to the standard approach.
Quality of Life (QoL): Due to faster continence and potency recovery, patients report improved QoL scores.
Comparable Oncological Safety: Despite higher visibility challenges, studies indicate no significant differences in biochemical recurrence (BCR) rates between RS-RARP and standard RARP.
Lower Complications: Evidence suggests RS-RARP may lead to a lower incidence of postoperative hernia and similar or lower overall complication rates.
PubMed Central (PMC) (.gov)
PubMed Central (PMC) (.gov)
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Limitations and Considerations
Learning Curve: RS-RARP involves a smaller, more challenging workspace, which may result in a steeper learning curve for surgeons.
Positive Surgical Margins (PSM): Some studies have suggested that RS-RARP could be associated with higher PSMs (specifically in patients with anterior lesions) compared to the standard approach, though not necessarily leading to worse functional outcomes or higher recurrence.
PubMed Central (PMC) (.gov)
PubMed Central (PMC) (.gov)
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These results suggest that, particularly in the hands of experienced robotic surgeons, RS-RARP can offer superior functional results for patients undergoing radical prostatectomy.
PubMed Central (PMC) (.gov)

PubMed Central (PMC) (.gov)
Single-port (SP) RALP is generally considered better for patient recovery, offering less pain, shorter hospital stays, and superior cosmetic results compared to multiport (MP) RALP. Studies show SP-RALP provides similar cancer control and functional outcomes (continence/erectile function) while using a smaller 1-inch incision.
PubMed Central (PMC) (.gov)
PubMed Central (PMC) (.gov)
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Key Study Findings (SP-RALP vs. MP-RALP)
Patient Recovery: SP-RALP patients often report lower postoperative pain, reduced opioid use, and faster discharge (frequently < 24 hours).
Oncologic & Functional Outcomes: Early results show similar prostate cancer control and similar or better recovery of urinary and sexual function compared to multi-port.
Technical Aspects: SP-RALP offers improved precision in limited spaces, especially through extraperitoneal approaches.
Limitations: SP-RALP has a steeper learning curve for surgeons and generally higher procedure costs.
Perioperative: Some studies suggest SP-RALP may have shorter operative times but, in some cases, higher rates of positive surgical margins, though most studies show comparable results to multiport.
UroToday
UroToday
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Conclusion
While multi-port is more common and supported by two decades of data, single-port is rapidly proving superior in terms of postoperative pain and hospital stay duration, making it a highly attractive, less-invasive option for patients.
European Urology
European Urology
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Single-Port versus Multiple-Port Robot-Assisted Radical Prostatectomy
Dec 7, 2021 — Single-port robotic radical prostatectomy was associated with shorter hospital stays. Only 60.6% of single-port patients (109/180) required analgesia compared t...
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PubMed Central (PMC) (.gov)

@wheel1
You cut this one a little short

Single-Port versus Multiple-Port Robot-Assisted Radical Prostatectomy
Dec 7, 2021 — Single-port robotic radical prostatectomy was associated with shorter hospital stays. Only 60.6% of single-port patients (109/180) required analgesia compared t...

@jeffmarc Arguing Single port surgery vs Radiation as the ‘best’ treatment is right up there with religion and politics and chocolate vs vanilla.
They both work for most, they both don’t work for others and every single case is different. Whoever or whatever school of thought you follow is obviously more comfortable to your way of thinking about how your cancer should be addressed.
The best surgeon on earth could never convince you to have surgery if you truly believe (thru research or simple gut feeling) that radiation is better - and vice versa…
Phil

I exhaustively researched treatment options prior t my decision to go with RALP. Both radiation and RALP are about equal concerning outcomes and possible side effects but once radiation treatment shrinks the prostate gland and causes fibrosis and scarring in the general area it is very difficult to surgically remove the prostate if there is a need to do so.

At 58, I went with surgery with the idea that radiation could be an option if things creep back up. Age and the fact that younger men generally recover better helped me make that decision. I did well. No incontinence. ED that was resolvable. I’m okay with my plan. My father and grandfather had radiation way back in history. I do support other men who feel it is the best choice. It certainly sounds like a good option. I also felt like surgery would get me past the focus on treatment and back to life. Just my brain.

@thig350 Just had surgery three days ago. The catheter is NOT a big deal. Is it annoying, sure. But, it's literally one week out of your life and then its gone. Do NOT base your decision on the whole catheter thing.... says the guy wearing one right now.

Also, don't obsess about catheter removal-not a big deal. I watched videos showing people getting them removed. Not a big deal.

I do admit to being freaked out learning about what they would do early on. Now, nah. Not a big deal. They put in when you are asleep. Removing it happens in a flash. Not a biggie.

I was in your predicament last year. My PSA was 5.9. It came up from 0.4 in 2001 to current level last year. I did the MRI and biopsy and got a slightly worse result than yours. I rejected the active surveillance and surgery that was among the options presented. As a retired nephrology and ICU nurse, I can sort of do research on other disease entities. I do have experience with dialysis patients also having prostate cancers or hypertrophy. I opted for androgen denial therapy (ADT - the drug decrease testosterone production in men. It fuels the growth of the tumors) or chemical castration and radiation. Both of these treatments have side effects and I had experienced some of them: hot flashes and urinary difficulties. I also had a gel implanted between the rectum and prostate to prevent the irritation or injury to the bowel. I am now a week after the last radiation therapy session and still dealing with the urinary problems but according to my care team, it should get better in 4-6 weeks. I did not look at surgery because I did not want to be physically limited even for a couple or more weeks. I am 'addicted' to my daily karate practice even after 54 years at 71 years old. Also, statistically, it was claimed that the efficacy between the two is the same. My radiation MD, oncologist and urologist said so although I believed DuckDuckGo (Google) more ;-). I feel great even if my hemoglobin dropped from 16 gms% to 13.5 gms% in six months from the ADT. I hope this helps. Good luck.