MA-RARP (Modified Anterior Robot-Assisted Radical Prostatectomy)
Hello Everyone. I was diagnosed with prostate cancer on 3/12/2026. I have intermediate grade prostate cancer, PSA= 12.9, stage T3a, Gleason Score 3+4=7, Extracapsular Extension (3mm), PSMA PET/CT shows no signs of cancer beyond prostate. My Decipher Genetic Test scored .70.
Can anyone out there recommend a skilled surgeon that can perform an MA-RARP prostatectomy?
I am located in California and I am looking for a surgeon who is experienced at MA-RARP, Modified Anterior Robot-Assisted Radical Prostatectomy, a refined robotic surgery for localized prostate cancer that removes the prostate gland while prioritizing functional recovery. It builds on the standard anterior approach by incorporating techniques like no-clip methods and bladder neck preservation to protect key structures.
This approach preserves the Retzius space—anterior to the bladder—avoiding disruption of the prostatic plexus, intrapelvic fascia, pubic prostatic ligament, and detrusor apron. Surgeons access the prostate via a retropubic space entry using robotic systems like da Vinci, maintaining tumor control without compromising margins.
This is NOT RS-RARP, Retzius Sparing Robot-Assisted Radical Prostatectomy, where the point of entry is posterior.
Does this approach ring a bell out there? MA-RARP uses da Vinci robotic systems for precise retropubic access, avoiding full Retzius disruption unlike standard anterior RARP. Modifications include no-clip dissection, bladder neck preservation, and careful anterior exposure to protect neurovascular bundles and fascia.
I am having a challenge finding a surgeon that is skilled at MA-RARP because most urological surgeons are trained on the Standard Anterior approach (SA-RARP) and the acronym, MA-RARP, is not widely recognized.
MA-RARP is a strong "middle of the road" choice. MA-RARP strikes a good balance for my T3a prostate cancer (3 mm ECE, Gleason 3+4=7, PSA 12.9, Decipher 0.70). It gives better early urinary continence control than standard SA-RARP (48% continent day 1 vs 6%, 100% by 3 months) while keeping cancer clearance rates similar (11% PSM vs SA's 9%).
Am I in "LaLa Land" with this approach? Please enlighten me.
Thanks for everyone's support and information, Nelson Lee
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@rlpostrp Thanks for the response. I hear what you are saying. I am no stranger to cancer as I was diagnosed with bladder cancer a few years back. After two TURBs and several BCG infusions, I thought I was leaving the cancer thing behind me.... then this prostate cancer comes along.... (a blank, emotionless, stare into space....)
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2 Reactions@nelsjenn
Where you live is a big factor. If you wanna know where good places to get treatment are in your area let us know where you live.
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1 Reaction@ekdart We have been talking with several surgeons at UCSF. Would you share the name of your doctor (surgeon) who is doing the dorsal hood approach? Thanks for the support and information.
@jeffmarc We are living in the Bay Area--- and we are familiar with UCSF. Regardless, feedback on good places to get treatment would be appreciated. Thanks for the support and care.
@nelsjenn My bladder cancer was actually found during my RARP…so when I woke up in recovery it was a ‘bittersweet’ event, to say the least!
As far as selecting a surgeon goes, I knew some of the bigger names in my NYC area just from hearing of their exploits in the local news, TV, word of mouth…
That last one was most important!
So I narrowed it down to two men, neck and neck, and chose the one who could see me almost immediately and not have me run a gauntlet of red tape to make his acquaintance.
Once I met the surgeon, I was even more impressed by his demeanor, friendliness and could see how he forged such a glowing reputation.
I told him plainly “You are the only thing keeping my head together at this point” and he assured me that he would take good care of me.
There are brilliant surgeons who have zero personality and are ice cold as human beings. There are other truly bad surgeons who are so warm and charming that you would let them operate right there on their desk with no anesthesia. So you have to be sure that all the reviews you read – and you do have to read some of these online, whether you like to or not – are a true representation of the person you are meeting.
I wish I could be more definitive in my answer, but when you meet the surgeon who’s right for you, you will know it instantly. Best,
Phil
@nelsjenn
You can’t beat UCSF
UCSF
GU Oncologists must have metastasis to get oncologist appointment, or be referred
Eric Small not real friendly but good
Rahul Aggarwal top notch
Terry Friedlander 2nd choice
Urologist Peter R. Carroll
Dr. Mack Roach Radiology away until November
Dr. Seyedin RO really good
Dr. Hsu RO
Dr. Gottschalk RO
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2 Reactions@nelsjenn
Dr. Carissa Chu is the urologist at UCSF that gave a talk at their recent conference about surgery. She should be experienced in the new techniques.
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1 ReactionI would like to add (UCSF) Dr. Julian Hong (RO), friendly, compassionate, extremely high intelligence and answers all questions personally (not via nurse) and in a timely manner. Ordered for us tests that were dismissed by other physicians there. He was actually recommended to us by one of the doctors at UCSF.
He got 5 stars on multiple "review" sites by hundreds of patients (not all have that rating BTW) but is modest and keeps a low profile.
However, I am sure that all ROs at UCSF are very capable and under tutelage of Dr. Roach who is alpha and omega there (and for a reason).
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4 ReactionsI would recommend Thomas J. Guzzo, MD, MPH Chief of the Division of Urology at the University of Pennsylvania.
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1 ReactionHi,
If that is the one incision method I have heard nothing but good things about it. Wish they had this when I had my 5 incision robotic removal 11 yrs ago.
Dave 3+4
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