At Gleason 9 forget focal therapy. Even with a clean PSMA PET there is a good chance undetected micro-metastasis will require future salvage RT. RT can cover both prostate and surrounding areas but may not be as through within the prostate. Nothing like removal with clean margins to be sure you have it all. I had a high probability of requiring salvage RT and that was a big factor in going with RT. Everyone must choose what is best for them.
>> And yes, if you go with RT you want SpaceOAR or another rectal spacer. Also want to use Orgovyx for ADT rather than Lupron. If ARSI is also used you want a second gen lutamide (Nubeqa, Erleada, Xtandi) rather than Abbie.