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MA-RARP (Modified Anterior Robot-Assisted Radical Prostatectomy)
Hello Everyone. I was diagnosed with prostate cancer on 3/12/2026. I have intermediate grade prostate cancer, PSA= 12.9, stage T3a, Gleason Score 3+4=7, Extracapsular Extension (3mm), PSMA PET/CT shows no signs of cancer beyond prostate. My Decipher Genetic Test scored .70.
Can anyone out there recommend a skilled surgeon that can perform an MA-RARP prostatectomy?
I am located in California and I am looking for a surgeon who is experienced at MA-RARP, Modified Anterior Robot-Assisted Radical Prostatectomy, a refined robotic surgery for localized prostate cancer that removes the prostate gland while prioritizing functional recovery. It builds on the standard anterior approach by incorporating techniques like no-clip methods and bladder neck preservation to protect key structures.
This approach preserves the Retzius space—anterior to the bladder—avoiding disruption of the prostatic plexus, intrapelvic fascia, pubic prostatic ligament, and detrusor apron. Surgeons access the prostate via a retropubic space entry using robotic systems like da Vinci, maintaining tumor control without compromising margins.
This is NOT RS-RARP, Retzius Sparing Robot-Assisted Radical Prostatectomy, where the point of entry is posterior.
Does this approach ring a bell out there? MA-RARP uses da Vinci robotic systems for precise retropubic access, avoiding full Retzius disruption unlike standard anterior RARP. Modifications include no-clip dissection, bladder neck preservation, and careful anterior exposure to protect neurovascular bundles and fascia.
I am having a challenge finding a surgeon that is skilled at MA-RARP because most urological surgeons are trained on the Standard Anterior approach (SA-RARP) and the acronym, MA-RARP, is not widely recognized.
MA-RARP is a strong "middle of the road" choice. MA-RARP strikes a good balance for my T3a prostate cancer (3 mm ECE, Gleason 3+4=7, PSA 12.9, Decipher 0.70). It gives better early urinary continence control than standard SA-RARP (48% continent day 1 vs 6%, 100% by 3 months) while keeping cancer clearance rates similar (11% PSM vs SA's 9%).
Am I in "LaLa Land" with this approach? Please enlighten me.
Thanks for everyone's support and information, Nelson Lee
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Great skilled surgeon in Orange County.
@wheel1 Can you be more specific? Thanks for the support.
With ECE, is nerve-sparing feasible on the side with ECE?
From what I have read, If MRI indicates definite ECE, the probability of having ECE is very high.
If MRI indicates possible ECE, then it is more of a 30-40% of actual ECE.
Are you also evaluating EBRT with Brachy boost or SBRT with Brachy boost?
Best Wishes.
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3 Reactions@charlesprestridge Excellent point- an MRI actually showing ECE could hint at a small break in the capsule; you don’t know until you’re in there.
Nelson, this surgical approach you desire sounds good but as anyone on this board who has had surgery will tell you, it’s all about the SURGEON - and not the surgical approach.
There are about 5 variations of the RARP procedure; they all have both positive and negative outcomes - especially in terms of SE’s - and I don’t think your variation is any different.
That said, any surgeon who has respect for the Retzius Space - regardless of anterior, posterior, or over the top approaches - should leave you in a better position as far as side effects are concerned.
Also remember that some of these ‘newer’ RARPs may not fully address the total removal of the cancer, which is why you are going under the knife to begin with, right?
If you are in Cali you have hundreds of excellent surgeons with long, successful track records…find that one person you feel the most comfortable with and let them use whatever robot or approach they choose! Best of Luck,
Phil
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Hug
6 ReactionsHi,
On your report you said “ Extracapsular Extension (3mm), PSMA PET/CT shows no signs of cancer beyond prostate. ”. So does that mean you have a cancerous growth on the outside of your Prostate gland but not outside of the Prostate?
Dave 3+4
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Hug
2 ReactionsUCSF uses this technique.
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3 Reactions@clevelandguy I believe my ECE is a growth outside my prostate, but not of the surrounding structures, such as muscles, nerves, or organs, have been affected. In other words, it is still contained at the prostate.
@jeffmarc Hi Jeff, My wife and I have spoken to UCSF, and our impression was that the surgeons do just SA-RSRP. Can you give me a name of a surgeon at UCSF? Is there a rule about not identifying specific doctors on this forum? Thanks for the support!
@charlesprestridge My wife and I had a meeting with a radiation physician at UCSF. He suggested 6 months of ADT (hormone therapy), 2 session of SBRT, and 5 weeks of IMRT (every week day). I am concerned about the long terms effects of radiation therapy to surrounding structures, like the bladder, nerves, and rectum wall. For now, I am thinking "treat the prostate" and "leave everything else alone". With that said, Is that a valid frame of thinking?
@nelsjenn
Hi,
Might be worth checking out, this is from Google.” Extracapsular extension (ECE) is a finding where prostate cancer breaks through the prostate's outer fibrous capsule and invades the surrounding fatty tissue or structures. “
Dave 3+4
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