If you read my prior posts those will provide more background.
Since my confirmed diagnosis earlier this year I have been doing extensive research and met with a variety of specialists. The info and support here has proven extremely valuable.
As I started my research I quickly put surgery as my least favorable option.
I first explored newer procedures like FLA and Tulsa. Unfortunately, the factual efficacy data for those does not support the anecdotal evidence. The recurrence rates are very high. There were plenty of clinics willing to take $40k or more to perform these proceedures. I would have gladly found a way to pay for them if they actually worked. The data just does not support it and I am too young to accept that risk.
My next great hope was radiation. What I did not plan for was the complications of radiation with a 96cc prostate. One of the worlds leading brachytherapy specialists ruled that out for me. I then looked at SBRT / Cyberknife. Met with 3 Radoncs who all said the same thing, that they would not recommend hyper fractionated RT due to my prostate size and history of BPH. They all felt that a traditional 8-9 week course if radiation would effectively kill the cancer but they were also open about the side effects and longer term risks.
So, it seemed that if I was being honest with myself that the best course for me, in my situation not necessarily yours, would be surgery. Now it came down to who and where which drive more research. Recently I learned about a modified robotic procedure called Retzius sparing. I read more and it seems to have significantly improved incontinence outcomes, most men needing no protection within as little as a week after. Also less shortening or pyronies risk. ED seems about the same. I corresponded with a surgeon in the UK who, even though he would not be getting my business from the US, felt that I would be a good candidate even with the enlarged prostate. I then reached out to surgeon at Georgetown who I also met with today. He is now exclusively using the Retzius proceedure having done 200 to date with excellent outcomes. We went over my MRI and he seems confident about successful Retzius sparing and nerve sparing.
And so, the decision is made. I now just need to schedule the actual date. I will not say I am happy with the decision, I would have likely done SBRT under different circumstances. However, I am very much at peace with my decision. I researched the hell out of options, talked to many specialists and, in the end, have made what I think is the right decision in my situation. Again, I emphasize that right for me may not be right for you. There is no perfect option here so in the end there is always a bit of a dice roll.
I will likely enjoy the next approx 8 weeks before going under the cyborg knife. Once that happens, I will be sure to share me experience and outcomes with all of you.
Thanks again for all the information and support even though I still wish I never had to know any of you. Hahaha.