Update: 42 years old, chose RALP

Quick summary of my situation: 42 years old, Gleason 3+4, PSA 5.4, low Decipher score, negative PET scan, cancer on the left and right side of the prostate but low % of Gleason 4. Some perineural invasion but all internal to the prostate. MRI showed lesions butting up against the capsule (grade 1 EPE) but everything likely still contained.

So, when I was researching I found it really helpful to hear what other guys decided on and how they came to their decisions. I figured now it's my turn now that I'm on the other side. Plus, it's a bit cathartic.

I started my journey freaking out. I went through the classic stages of grief: from initial fear to denial, bargaining (tons of research, lots of doctor meetings), depression about the whole situation and finally acceptance and then a decision. From diagnosis to procedure was 4 months. And I'm glad I took my time.

I met with 6-7 different doctors, surgeons, oncologists, radiologists, etc, local and across the country. I've never before been told so many times how young I was.

All save 1 recommended RALP.

The main reason across the board: my age. Some had better reasons that others when I pressed them on it. Perhaps the strongest though was the surgeon I ended up going with. He emphasized that though this was a curable disease and quality of life was really important, if longevity of life - long term survival - was my top priority then given the extent of the disease at my young age, the length of time for the odds to work against me (40+ more years hopefully), I could be looking at a primary, secondary and perhaps a third treatment over the course of my life. Given that, he felt surgery was my best option to maximize those odds. The longest runway so to speak.

I have a wife and kids and longevity is absolutely my top priority. Study lengths are what, 10-15 years max, maybe a couple going 20 years. In 20 years I'm not even retired! So we're making educated guesses at what happens for long time frames. 40 years is a lot of time for the cancer to come back, regardless of the treatment.

So, I chose RALP. No guarantee it works out in my favor, but even so, I was at peace with the decision and I don't regret my choice.

Still, I could see someone in the exact same situation but having different priorities making a totally different choice. There is no right/wrong answer. Radiation is still a fantastic option, just in my situation it didn't look to be the best option for my priorities.

I'm 10-ish weeks post-RALP now and feeling good! I'll probably make another post about the whole recovery process, side effects, etc. I had an excellent surgeon at a center of excellence that I'm blessed to only live an hour away from. Good news is the pathology report looked very promising. Negative margins and the surgeon was happy with how it went. They did find some extracapsular extension - it was poking through the prostate just a bit, rather just abutting like the MRI showed. But still, it looked to be fully contained in what they cut out. So they got it just in time. They also took out some lymph nodes and those all came back negative. I was so so relieved to hear that!

Next up is a blood test in August to see what PSA levels are. Hoping and praying it's undetectable!

But that's all for this installment. Grateful to be alive and learning to appreciate every new moment I'm given. Hope ya'll are doing well and good luck on your own journeys.