My experience may not be typical so cannot be relied on to set a president but aspects of it may be of interest to Van.
I was diagnosed with PCa in 2007 whilst living in Surrey and started HT at the Royal Marsden in Sutton with the expectation of having RT there. In the event, I decided to have non standard RT in Germany within a study. with follow up there for three years. However, the Royal Marsden agreed to continue to monitor me, even after I moved to Devon. Several years later and following an MRI scan it was decided I needed further treatment as a (new?) tumour was growing within my Prostate. The Royal Marsden then referred me to UCLH treatment with HIFU or Cryotherapy as suitable within a Trial in 2014. I was given HIFU in 2015. Following this, UCLH suggested I might wish to be monitored by an Oncologist in Devon rather than by them. However, I considered the range of treatment available in Devon and the level of expertise here to be less than in UCLH and they agreed to continue to monitor me. So I had PSA tests done locally but continued to be monitored by phone and I attended UCLH in London for MRI. This proved to have been a good decision because after an initial drop my PSA again began to slowly increase to the point that further treatment was needed. Had I been monitored by a local Oncologist, I am sure I would only have been offered HT but still being under the aegis of UCLH I pressed for a repeat HIFU which was done in December 2021.
There are of course other centres of excellence and I would suggest anybody with PCa thinking of moving to an area lacking reasonable access investigate how easily they can be cared for elsewhere. My situation may have been helped by having taken part in trials and follow up from them.
On another aspect raised in this thread, not wishing to treat older men , particularly with robotic surgery, can be due to the unusual load positioning on the patient imposed by the procedure and other more likely contraindications.
There is doubt about the usefulness of super sensitive tests and some of the top hospitals who have both private and NHS patients subscribe to this view so I don't think it illustrates hospitals who use super sensitive tests are superior to NHS labs who don't.
There does appear to be considerable disparity in diagnosis in the case mentioned which requires further clarification but sometimes it can be a matter of different interpretation. For example UCLH considered from a Choline scan that I had that an iliac Lymph Node affected by cancer which would have meant no repeat HIFU. However, 3 other hospitals I sent the scan to doubted this. I then paid for a 68 Gallium PSMA scan which showed no cancer in it and eventually got my repeat HIFU. So interpretation can be very important although sometimes differently assessed.