RALP or SBRT for a 51 year old?

Since your Gleason score is low and volumes also low, I agree with posters who suggest researching focal therapy like TulsaPro.
Much less in the way of SE’s and if nothing else, may delay a more permanent solution for years. However, please get a Decipher Score done as it is pretty accurate for aggressiveness; this test alone can be the decision maker for you.
Also, from your posts it would seem that you favor treatment of some kind vs AS, but please bear in mind that this disease has NO permanent guaranteed cure, no matter what category you are in. View your treatment as possibly being sequential: start with the least invasive option (due to your age) if your Decipher score allows it and you can increase the aggressiveness and scope of treatment should it become necessary…Best,
Phil

I chose Tulsa Pro for my 4+3 at age 65. I liked the low risk of side effects and the fact that all other options were available if needed down the road. 1 1/2 years later and no evidence of disease. Also zero side effects and the procedure was painless. No long term data on success (3 year data is similar to RP & radiation) but I was ok with just kicking things down the road a bit and having more years without side effects.

@jcf58 Was your 4+3 focal? I was told that TULSA to the whole gland would make surgery later on much more difficult.

My quick story. I was Gleason 6 and chose AS. I believe it was the right choice for me. My doc’s reminded me that PC is one of the most over treated diseases! (Caveat, I had 2 surgeries for colon cancer about 18 and 12 months prior to confirming that I had PC. I appreciated the break.) After 18 months of AS my Gleason was 4+3, and it was time for some type of treatment. After looking at all the options, I chose to do RARP in mid December. One thing regarding various side effects of RARP vs SBRT, etc. According to my docs, the side effects graphs merge within 2-4 years. With RARP symptoms generally improve with time. With radiation, they typically decline over time. BTW, I am 64. Anyway, I am 8 week post surgery and 6 weeks after my catheter was removed. I too was very concerned about incontinence. The first 2 weeks were a real learning curve, but I have been quite pleased with my progress towards continence. FWIW, you are young and will likely have fewer side effect issues than us older fellas. Please get a 2nd and 3rd opinion and research the heck out of it. Then, make your decision and embrace it fully. Whichever way you choose to go, it is the correct decision for you! No second guessing, just go with it. I’m pretty early in my post RARP journey. Continence is improving and I’m hoping to regain my sexual health. For me, AS followed by RARP was the right path. I’m confident you will choose the right one for you as well!

@topf
I only had 30% of my prostate ablated with Tulsa. Surgery can be tougher because of scar tissue. Mayo told me that they do it successfully regularly. Also, I had already determined if I need further treatment down the line I would go with radiation.

@jcf58 Thanks for the info. I wish TULSA had been an option for me with Gleason 4+4 at biopsy (downgraded to 3+4 at pathology).

It is possible to do ultrasound or cryo? These therapies are not as absolute as surgery or radiation. But I think if you use ultrasound or cryo, radiation and/or surgery are still available later in life. Active surveillance is not good for your mind since you know your dad died of PC.

My husband has PCa, and is having surgery March 9th. The surgery is robot assisted simple prostatectomy. RASP. They will basically core out the prostate, going through five incisions in the abdomen. It is similar to TURP, except for point of entry. Hubby will have 28 radiation treatments after healing from surgery, to get rid of the cancer. RASP is ideal for large prostates, but it can be done on smaller glands as well. My hubby’s prostate is 160cc. The reason I bring this up, is that the ureter does not have to be shortened as much as it would in a radical prostatectomy. The nerves are not affected either. His urologist says there is very little chance of ED or incontinence. Yes, it is two prong treatment, but a lot of men have to have radiation after surgery anyway. Why not see if RASP would work for you? RASP is being touted as the new gold standard for BPH. Hubby does have BPH, so surgery will take care of that, and then radiation will address the cancer.

@mtcoastie You've probably already done this, but I would suggest you ask how RALP, focused ablation, and/or radiation might affect your minor stress incontinence, as well as how the MDs feel about you making that a primary decision point in treatment choice. From my perspective as a layman, I'm not sure that your current incontinence issues would be a good predictor of incontinence issues after treatment. For instance, many men have issues due to enlarged prostates, which certainly disappear after prostate removal, but not so much after radiation produces scar tissue in the enlarged prostate. Someone please correct me if I'm wrong about this.
In my case, at 65, my post-RALP incontinence resolved fairly quickly while my issues related to benign prostatic hyperplasia disappeared completely (in hindsight, duh on this second question!)