@keithl56 There is natural bias to recommend what you know so surgeons will recommend RARP even if they perform it poorly and will believe it is the best even when it is not. As far as ADT it probably does more damage than good for 3+4 local disease but is essential for metastatic disease. For AS: Did you get a decipher test? What is the doubling rate of your PSA? Those are among the factors that indicate how aggressive your disease is.