MA-RARP (Modified Anterior Robot-Assisted Radical Prostatectomy)

@heavyphil Thanks for your perspective. We agree that the surgeon is the most important consideration with any of these approaches --- Can you please share what your surgical experience was?

@nelsjenn
Dr. Carissa Chu gave the talk on surgery at the April 17, 2026 UCSF patient conference.

Dr. Peter Carroll chaired that section of discussions. He is a urologist who does prostatectomies.

I’ve included the slide where she showed what you are looking for.

Retzius sparing was a major point of the discussion.

@nelsjenn

No, there is no such rule here. Some people are just reluctant to do so. My husband had very good surgeon at UCSF but I think that there are even better ones out there, JMHO. I am however perfectionist, so maybe I judge too harshly.

My compliant is not about SA - my husband had very fast recovery, but one margin was "inconclusive" according to pathologist ( surgeon of course states that it is negative to this day *??? ), and one margin too close to unifocal EPE, and now my husband has BCR. So - yes, ZERO incontinence and almost back to normal regarding AD, BUT what does it matter when some cancer was left behind ???

As @heavyphil said wisely - keep your focus on cancer eradication because all the rest looses charm if you have BCR soon after RP.

UCSF is very busy and very slow moving, we had to practically fight for many things to be done on time and are still dealing with untimely scheduling even though my husband is high risk and with fast doubling time at the moment.
We had to schedule PSMA test in another hospital now just to do it in time and not risk his PSA being 0.5 before salvage treatment starts ! All in all - I can not say that I can wholeheartedly recommend UCSF. BUT, we are experience of one.

Wishing you all the best and the best of luck 🍀🍀🍀

@nelsjenn

I have not had treatment. I meet with surgeon to discuss. I have possible ECE. We will discuss nerve sparing, lymph node sparing, surgical margins, ect, during the visit.

With definite ECE, you will have to discuss options with surgeon(s).

I do not know how they can spare all the nerves with 3mm ECE and try to ensure negative margins. This will be a main part of your discussions and fact-finding.

This is what you will have to weigh with Radiation options.

I do not have a recommendation for treatment path.

You will want to get Prostox test(s) to help predict future possible radiation toxicity issues.

Then study all your options.

Best wishes.

@nelsjenn I had DaVinci RARP in 2019 by Dr David Samadi. I was Gleason 4+3 unfavorable and surgical pathology showed all negative except a ‘tiny’ break in the capsule, which did NOT show on MRI.
No long term continence issues, but persistent ED; suffered recurrence 5 yrs later and had SRT with ADT.
My cancer was extensive (PNI) and I consider myself lucky that it did not spread further.
If you’ve been on this forum for a year or more you will hear every possible combination of both positive and negative factors in all surgical cases.
Even with the best surgeon, totally negative surgical pathology, low Decipher score, no genetic issues - men STILL suffer recurrence 30% of the time; that’s a fact.
So that’s why I suggest you blot out the nuts and bolts of the various procedures and focus on the surgeon: his/her reputation, track record, ability to answer all your questions without reservation and your comfort level with them.
These are only my personal observations having been thru both surgery and radiation and having met my quota of doctors - many winners but some definite losers! Be Well
Phil

https://connect.mayoclinic.org/discussion/good-video-on-rarp-and-nerve-sparing/
Good video on anatomy of prostate, encapsulating layers, nerves, and some goals of nerve-sparing surgery.

My Surgeon has indicated:

-In Surgery, Surgeon cannot tell the difference in cancer cells and normal prostate tissue.

-Surgeon is trying to peel away prostate from wall (like in the video). Again, without being able to distinguish between cancer cells and normal cells. Surgeon has to use MRI, Biopsy, and how the prostate peels away during surgery, etc to decide how much to cut out.

-Watching the video reminds me of the joke of Why the surgeon charges more per hour than the auto mechanic.

Mechanic says he works on very complicated equipment similar to the surgeon.

Surgeon says, try changing a starter thru the muffler with the engine still running.

Amazing how skilled surgeons operate the robotic attachments.

Best wishes.

@charlesprestridge
That video is really eye-opening. I guess if you do a few hundred of them you get an idea of what things look like.

Prostate cells are a different color and shape so over time doctors must become familiar with those differences.

I apologize to you and everyone who reads/contributes here for my fatalistic comment, but what I have found in my own journey, and that of reading about everyone else's journey - with their unexpected detours off of what we/they thought was a straight path to recovery - is (quoting a famous movie line): "You can do what you want, but the outcome will be the same."
I have read SO MANY stories of men being surprised by their surgical pathology report that revealed so much more than their initial biopsy that was paired with a lower Gleason Score. I have read of men, who after 5 - 10 years of no sign of post-RP disease what so ever, offer that their cancer has returned, even though there was no identified Extraprostatic Extension or Surgical Margins documented in their surgical pathology report years before. I have read of men who, after RP surgery, had to go through radiation therapy, and yet five years after that, their cancer return anyway, so now they are on ADT. And so it goes.
So, my message is: to keep yourself emotionally balanced. Find a top university-based medical center where the best research and cutting-edge surgical techniques are happening, and travel there for your surgery. That is your best hope, but...that said..."stuff" can still happen years later that will leave you reeling. That is why this blog exists with all of us who read and contribute.
I have offered this many times before but: This blog is for the "unlucky ones"...the ones who had something unexpectedly "go wrong." The "lucky ones" who had clean surgeries, prostate-confined cancer, and restored ability to urinate and have sexual intercourse within a reasonable amount of time after surgery, are "not" in this blog. We are the exceptions...the outliers...the "unlucky ones," whose disease took their unexpected twists and turns, and just keeps coming back. So, my hope is that we here, will never hear from you again because everything went well for you. But should you return to us, well...we'll all be here for a while telling our unexpected and insane stories of "the latest" that has now happened in the next phase of our journey.
BTW...The movie: "A Passage to India" (1984). The quote spoken by an Indian mystic who tries to calm the extreme anxiety of a native Indian man who obligingly/submissively gave his own rear shirt collar stay to a visiting, high-level Englishman who was missing his. The panicked Indian man knows that he will be seen in public without a rear collar stay, and he will be ostracized for it in 1920's Indian society. He is in a total panic, and the Indian mystic calmly says: "You can do what you want, but the outcome will be the same." Somewhat humorous, while being true. You can drive yourself crazy with worry, but in simplest re-stated terms: "what will be, will be", and you just have to take it as it comes. Good luck.

@jeffmarc
Hi, I believe this is called a dorsal hood approach, and the doctor at UCSF we are consulting with does this. His recommendation to us is 'robot-assisted radical prostatectomy (single port daVinci robot) and he is a potential candidate for nerve sparing (dorsal hood approach)'. We are also considering EBRT, without ADT, because he is intermediate risk with a low Decipher score.

@heavyphil Thanks for your support and feedback. My wife and I hear you. We have been weighting in the tradeoffs of each approach, but we realize the surgeon's skill, experience, and my rapport with the doctor is critical. Can you share with me your experience with finding the right doctor? We have working with hospitals and making appointments to meet with surgeons. It seems like a "hit and miss" process. And often this process feels random, time consuming, ineffective, and the collection of these "introduction" appointments are getting expensive.