@charlesprestridge Excellent point- an MRI actually showing ECE could hint at a small break in the capsule; you don’t know until you’re in there.
Nelson, this surgical approach you desire sounds good but as anyone on this board who has had surgery will tell you, it’s all about the SURGEON - and not the surgical approach.
There are about 5 variations of the RARP procedure; they all have both positive and negative outcomes - especially in terms of SE’s - and I don’t think your variation is any different.
That said, any surgeon who has respect for the Retzius Space - regardless of anterior, posterior, or over the top approaches - should leave you in a better position as far as side effects are concerned.
Also remember that some of these ‘newer’ RARPs may not fully address the total removal of the cancer, which is why you are going under the knife to begin with, right?
If you are in Cali you have hundreds of excellent surgeons with long, successful track records…find that one person you feel the most comfortable with and let them use whatever robot or approach they choose! Best of Luck,
Phil

@charlesprestridge My wife and I had a meeting with a radiation physician at UCSF. He suggested 6 months of ADT (hormone therapy), 2 session of SBRT, and 5 weeks of IMRT (every week day). I am concerned about the long terms effects of radiation therapy to surrounding structures, like the bladder, nerves, and rectum wall. For now, I am thinking "treat the prostate" and "leave everything else alone". With that said, Is that a valid frame of thinking?