Thoughts on treatment options?

In brief, diagnosed Gleason 4+3 at 59 in Dec 2025. Retzius, single incision RALP Jan 2026. I chose the surgery for a few reasons. I am working and radiation would be most disruptive for work and I would need ADT with my risk being higher at 4+3. Wanted to avoid ADT. Otherwise, I would likely have had radiation. Surgery was very successful. Currently undetectable. No real lack of continence, except a bit of stress incontinence which resolved in less than two weeks after catheter. Natural return of erectile function progressing 7 mos post surgery. Utilize Trimix for sexual intercourse. I have zero regrets and am very grateful 🙏🏽. There is no right way, but this was best for me. Hope this helped a bit.

Currently waiting to see Urology surgeon on Sept 28th, saw oncologist last week waiting for decipher test to make decision diagnosed with 2 cores 3+4 taken from .8cm lesion, oncologist recommended 5 sbrt treatments with a 90% cure rate or 95 % with adt, to me the extra 5% is not worth taking it. Would rather do radiation but not with high decipher score, will see what happens.

@tattodice glad to hear things worked out for you.
I’m having trouble trying to figure out what facilities offer the best nerve sparring options like Retzius.
Were you in a similar situation of just happen to already be involved with a facility that offered this?

@ginger38314 Did you get the decipher results back?
My Prolaris just came back and put me in the low end but still unfav inter risk

No, but I just need to have them by 9/28 for Urology surgeon so I can make
a decision. That's great yours came in low even with unfavorable Gleason 7
you should have a good outcome no matter what you choose.

@ireland1964

Kind of an interesting story. I work for a physical therapy company in Indiana. There was a urologist, Colin Linke MD, who sent us a lot of referrals for pelvic floor therapy. Then he left the health system that had employed him and opened an independent practice an hour south of Fort Wayne to ride out a non-compete. A year later I found out he was returning to establish his practice here in November 2025. I was somewhat aware of his expertise in this area. My primary care doc referred me to urology based on elevated PSA a couple weeks before he opened his doors. I got on his schedule and was one of his first patients. Great guy! I know a lot of physicians as I call on them in my work. He struck me as unique and I could not deny that our meeting was fortuitous, an orchestration by God. Very grateful to him and to Him!

Where are you located? I was a patient navigator at one point. Maybe I can help.

@ginger38314 For what it’s worth, My Dr didn’t have anything & I had to call the lab that performed biopsy to get Prolaris results.
My “2nd opinion” with Karmonas cancer center was a disappointment. Their GU claim to have everything reviewed by a team (rad, surgeons, path etc) and develop a specific plan ready for your appt. didn’t work out that way.
Feel like I’m back to square one and starting to think I’ll just focus to find best NS-Ralp and be done with this.
Hope you get better guidance. Were you looking at the Proton Sbrt & a spacer?

@ginger38314 For what it’s worth, My Dr didn’t have anything & I had to call the lab that performed biopsy to get Prolaris results.
My “2nd opinion” with Karmonas cancer center was a disappointment. Their GU claim to have everything reviewed by a team (rad, surgeons, path etc) and develop a specific plan ready for your appt. didn’t work out that way.
Feel like I’m back to square one and starting to think I’ll just focus to find best NS-Ralp and be done with this.
Hope you get better guidance. Were you looking at the Proton Sbrt & a spacer?

@tattodice I’m in Michigan and recently had a consult with Karmonas Cancer which honestly didn’t offer any clarity or direction other than surgery or radiation as an option.