Focal Therapy is the option you must consider.

The RRP (retropubic radical prostatectomy) can be performed using an open (incision with a knife, laparoscopic, or robotic assisted approach. However, the toxic side effect profiles are similar between all of these different approaches. This option is the entire removal of the prostate as well as a lymph node dissection in select cases. The PSA should drop to undetectable and in this case, the PSA is an excellent predictor of recurrence. However, failure that is represented by leaving prostate cancer behind or biochemical failure where the PSA starts to increase can happen in 32% of the patients at 25-year follow up as reported from John Hopkins.2

Intraoperative risks include adjacent organ injury, in particular, rectal injury, and bleeding. Postoperative risks include but are not limited to deep venous thrombosis, pulmonary embolism, heart attack, stroke, and death. There are bladder neck complications from re-connecting the bladder to the penis after prostate removal. However, the most common complications, as reported from a Harvard Medical School teaching hospital, are 25% incontinence and 75% impotence in their robotic RRP series.3 12 year follow up after RRP revealed that there was a 7 fold higher risk for urinary incontinence and sexual dysfunction.4

The other traditional therapy is radiation for prostate cancer which is either brachytherapy (permanent metal seeds) or external beam radiation. The use of concomitant hormone therapy (ADT) as an adjunct to radiation therapy is used for aggressive cancer where radiation alone may not be as effective. However, despite all of the progress in radiation, this modality still
has a 32% failure rate where positive biopsy for cancer were detected after radiation treatment in a meta analysis of 22 studies.5 There are different side effects profiles between surgery and radiation, and radiation side effects usually happen later than surgical side effects. 12 years after radiation, there was a 3 fold increase of bladder cancer and a 100 fold risk of radiation cystitis and proctitis.4 In the latter cases, the bladder or rectal lining has been burned by the radiation which leads to bloody urine or diarrhea. However, the potential damage to the rectum can be diminished by rectal spacers.6

Since both removal of the prostate and radiation can create many other problems, the idea of active surveillance (AS) was proposed. It is usually for low grade or nonaggressive prostate cancer since the treatment for these innocuous types of cancer could be worse than the disease themselves. However, about 50% of men on active surveillance will get traditional therapy within five years and then also suffer the same side effects of potentially wearing a diaper or not being able to have sex. Focal Therapy has been proposed to extend the length of active surveillance so that men can avoid traditional therapy altogether.7 These criteria continued to evolve and the protocol for active surveillance is also not standardized.