@ireland1964 don't know what part of the country you are in but if I was going to do RP surgery I would try to find a really good surgeon who has done hundreds of these surgeries and from what I have read get in the best shape of your life and do lots of Kegels prior.

@ireland1964
Here are some information about focal therapy from ancan.org and the actual links to the original articles.

Among US patients who received focal therapy for prostate cancer in the most recent decade, half were outside guideline-recommended care.Clinical practice guidelines currently recommend focal therapy for use in intermediate-risk disease only in clinical trials or prospective registries, not routine clinical practice. In low-, high-, and very high- risk disease, no level 1 evidence is available to guide treatment decision-making about the use of focal therapy.

To better understand contemporary treatment trends, investigators analyzed data from the 2010-2023 National Cancer Database (NCDB) including 1,179,384 men aged 50 years or older with nonmetastatic prostate cancer. Inappropriate focal therapy use was defined as receiving focal therapy for low-, high-, or very high- risk prostate cancer.

Overall, 15 672 patients (1.3%) received focal therapy, but 51% of these cases had low-, high-, or very high- risk disease, Quoc-Dien Trinh, MD, MBA, of the University of Pittsburgh Medical Center in Pittsburgh, PA, and colleagues reported in JAMA.

From 2010 to 2023, focal therapy use increased among men with favorable intermediate-risk cancer (2.1% vs 2.9%; P <.001) and decreased among those with unfavorable intermediate-risk disease (2.5% vs 1.9%; P <.001). The investigators were unable to assess the appropriateness of focal therapy in intermediate-risk disease because the NCDB does not specify whether patients were enrolled in
clinical trials or registries.

Focal therapy decreased among patients with high-risk (2.1% vs 0.9%; P <.001) and very high risk disease (1.8% vs 0.5%; P <.001), respectively.

Groups with higher adjusted probability of receiving focal therapy included men with older age, greater comorbidity burden, non-private insurance coverage, and treatment at non-academic facilities or higher volume facilities.

Focal therapy modalities shifted over time. Cryotherapy use decreased (79.8% vs 19.1%), whereas laser ablation (14.6% vs 45.8%) and high-intensity focused ultrasound (5.6% vs 35.1%) use increased.
This study was limited by a lack of data on adverse effects, treatment outcomes, retreatment rates, and costs. “These findings underscore the importance of distinguishing selective investigational use from routine adoption of focal therapy ahead of appropriate evidence,” Dr Trinh’s team concluded.“

These findings underscore the importance of distinguishing selective investigational use from routine adoption of focal therapy ahead of appropriate evidence.

In an accompanying editorial, Spyridon P. Basourakos, MD, Jonathan E. Shoag, MD, and Daniel E. Spratt, MD, from Case Western Reserve University in Cleveland, Ohio, compared real-world focal therapy use for prostate cancer to Hans Christian Andersen’s tale, “The Emperor’s New Clothes.” “Group think,” in the form of professional societies, opinion leaders, reimbursement incentives, and market competition, appears to have influenced clinicians’ decision-making even in the absence of clinical trial evidence. They cautioned that just because a technology is available and lucrative, it may not be in individual patients’ best interest.

“Clinicians in this field need to commend colleagues who openly report findings that raise awareness and question practice trends, especially when those practices are being adopted ahead of the evidence…,” the editorialists wrote. “It is to be hoped that academic leaders and professional societies pause to ask whether endorsing, promoting, and offering unproven and potentially harmful treatments outside of clinical trials truly serves the best interests of patients with cancer.”
https://www.renalandurologynews.com/news/half-prostate-cancer-focal-therapy-cases-inappropriate-treatment-risk/
Focal Therapy in Spotlight: Could Landmark Study Rewrite PCa care in UK? What About US?
https://howardwolinsky.substack.com/p/focal-therapy-in-the-spotlight-landmark
Here is the full UK article
https://www.sciencedirect.com/science/article/pii/S030228382602169X