Too many factors go into that decision to say "right or wrong..." in my opinion.

I had my surgery in 2014 when I was 57. At that time, based on the available imaging, CT and Bone scan and Biopsy, TRUS, my life expectancy and PSA, surgery was my choice. The surgeon was experienced and it went "well." When he reviewed the pathology report, T2CNoMx and his surgical notes, he opined "Kevin, you shouldn't have any problems with recurrence in the future...!" The surgery was nerve sparing and I did regain sexual function with the help of a daily cialis. I had zero incontinence, zero!

Two of my good friends also had surgery by my surgeon, theirs never came back though both have ED.

Sill, I knew that statistically I had a 30% chance of recurrence based on my GS 4+4...sure enough, 15 months later. So, I believe my decision was the "right" one, just didn't have the outcome I was looking to achieve, the gold ring (think riding merry go rounds when we were kids and the gold ring was the prie, a free ride!). Why did my surgery not "cure" me..? I expect that there was already disease in the pelvic lymph nodes, just couldn't be seen with the state of the art imaging at that time.

Today, with the PSMA imaging, I may have more clinical data with which to make that decision and certainly more treatment options than in 2014 which were pretty limited - surgery, radiation...Even so, there is some data which supports taking out the mother ship, the source, so one who is diagnosed today and with imaging shows prostate cancer outside the prostate, may still be faced with a decision, take it out or....?

Today, a person also has many non-surgical options, doublet, triplet therapies, ADT, ARIs... Throw in genomic testing...

Generally, treatments have side effects, some immediate and get better, some show later.

My medical team admits that if you put one hundred urologists, oncologists and radiologists in a room, presented a clinical case, you could not get agreement on a treatment plan.

So, back to my original thought, I do not believe there is a right or wrong answer about surgery, it is a choice based on clinical data, personal preferences and the trust in your medical team's skills and input - shared decision making.

Kevin