question for gleason 7 or above with nerve sparing prostatectomy

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Veteran Member

Date Joined Apr 2008
Total Posts : 1132
   Posted 8/12/2008 9:50 PM (GMT -6)   
i have been reading some posts regarding removing of lymp nodes during surgery and wondered how many of you had nerve sparing surgery.  also, did your surgeon discuss it with you prior to surgery.   my surgeon told me he hoped to save my nerves but never asked if i wanted them removed.   my gleason was upgraded to 8 post-op but surgeon was able to save the nerves.  I assume he could tell if they needed to be removed during surgery?   my 3 month psa was <.04 so i should be happy instead of worrying but just wondering what you all did.  still having problems on the ED issue but i know that is normal (and  may be psychological since i am thinking about the nerves!).
kcragman - if you are out there, how did your 3 month psa turn out.  your surgery date was close to mine.  hope all is well.
Age 48
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
decision - surgery (robotic)
surgery may 9, 2008 - houston, tx
pathology report -gleason 8
margins clear
4 week and 6 week PSA >.04 (undetectible)
12 week PSA <.04
continent at 10 weeks (no pads!)
kegel's twice a day 20 reps

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 8/13/2008 6:28 AM (GMT -6)   
My surgeon did nerve saving surgery.  He told me he would leave them, unless he detected spread of the disease into them, in which case he would remove whatever was necessary.  He also told me if he found that it had secaped into the abdomen and/or adjacent organs that he wouldn't remove the prostate, but would close up and fall back on radiation and chemo. 

James C.
Co-Moderator- Prostate Cancer Forum

Age 61
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07 ED- begin 50mg Viagra and Vacurect pump nightly, Fully continent
1/14/08 Caverject started/stopped, aching. 2/24/08 .5ml Bimix started-success
7/31/08 ED- Viagra, pump continues, no response- Trimix .10ml x 2 weekly continues
Post Surgery PSA's:  3 mts-0, 6 mts.-0, 9 mts.-0.

Regular Member

Date Joined May 2008
Total Posts : 260
   Posted 8/13/2008 6:47 AM (GMT -6)   


..mine as well, he did discuss the fact he would most probably be able to save the nerves. He also reminded once inside and looking around, so much can change, which is the main reason I went with surgery. To actually see what was going or growing inside me.....and trusted he would take care of it. We put alot of faith in those guys, they know it, we know reason it's (if not THE reason) so important to ask questions and feel comfortable with your Doc..

   age: 53
   Pre-0p PSA  Feb. 08, 5.0
      4.22.08, 4.1
      PSA  spiked once about 8yrs ago to 5.0 three months later
      back to 2.9...then into the 1.2 range until my re-scheduled 
      "missed" appointment this past Feb.
      Biopsy 5.1.08 
      5 of 15 cores positive
      Da Vinci I read somewhere on this 
      site....."the first show of the day"
       DaVinci completed 7.29.08, Bladder Sling installed, hernia repair 
       completed during surgery.    
       3hrs in surgery, 2 in recovery...trouble starting the airway pre-
        Sent home 30hrs,  JP drain in place 7days, catheter remains..
       Path report "cancer fully contained"....Margins clear
        Cath removed 8.8.08(ten days) lightly used pad 24 hours
        ED therapy begins 8.9.08. 100mg viagra three times a week,
        pump everyday and hold for ten minutes.
        "just tryin' to reason with hurricane season"....

Roger G
Regular Member

Date Joined Apr 2008
Total Posts : 150
   Posted 8/13/2008 8:33 AM (GMT -6)   
Luckily my gleason score did not increase post surgery.

During the initial consult with my urologist he felt a ridge/bump the side of my prostate. I went under the knife assuming one set of nerves would be lost do to this. He said it might be spared, but only after he had a look see.

I left the operating room with both nerve bundles intact, but nothing works yet. One the bright side my PSA is coming in at 0, and I am still inside the two year window for erection recovery. One can only hope.

Age: 43 (2008)
DRE Small Ridge on prostate, PSA 1.5
07/2007: Diagnosed cancer, T2c, Gleason 3+4=7
09/2007: Laparoscopic prostectomy @ Hamilton General, 4 hrs.
              Both nerve bundles spared
              Pathology Report: Tumor confined w/in prostate
              T2c, Gleason is 3+3=6
              Went home with JP drain
10/2007: Made return trip to hospital.  All urine was comming out JP drain.
10/2007: Catheter removed. Next to no leakage
11/2007: 1st PSA <.003 :)
              ED: Started Viagra, no response yet.
12/2007: Had confidence to go padless!!!!!
12/2007: ED:  Stopped Viagra as it's causing hemroid problems.
01/2008: 2nd PSA <.003 :)
              ED: next to no response.
04/2008: 3nd PSA <.003 :)
              ED: next to no response.  Changed the Viagra prescription.
07/2008: 4nd PSA <.003 :)
              ED: Still NADA.  Changing to Cialis.

Regular Member

Date Joined Apr 2008
Total Posts : 270
   Posted 8/13/2008 8:57 AM (GMT -6)   
This is an interesting subject. I spoke to two different surgeons on my way to DiVinci (one an open surgeon and the other my DiVinci surgeon), and when I asked the question about what they could see when in surgery as far as cancer, both indicated that discerning cancer cells from other cells during surgery was next to impossible.

In my situation I was told by the surgeon going in that he would cut a wider swap (sparing some nerves but not all) because the biopsy showed cancer on both sides, and its close proximity to the prostate neck. The focus was on preventing positive margins. The surgeon said as far as nerve sparing is concerned that it is never a situation of all or none, but somewhere in between.

From what I have read of others, I am expecting the worst or at least a long road to recovery of ED. On the positive side, among the good things about being in recovery is that there is always hope. Time will tell for all of us. RB
Age 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA .04

Navy corpsman
Regular Member

Date Joined Aug 2008
Total Posts : 61
   Posted 8/13/2008 9:09 AM (GMT -6)   

During my initial consultation Dr. Partin said he was going to remove the nerve bundle on the right side because of the tumor size and its location.  He never mentioned the lymph nodes.  I think he removed so many as a precautionary measure.  As I gather more information, I am glad that he did.  I cannot say enough good things about Dr. Partin.  He has dedicated his working life to understanding PCa and understanding which procedures and medicines work best in the fight against this horribe disease.

Does anyone understand the effects to the lymph system when lymph nodes are removed?

- John

Age:  44
We have a family history of PCa.  My Dad and uncle died from it at 65 and 53. My PSA velocity increased in the last 2 years and I had to talk my GP into refering me to a urologist.
Biopsy results:  5 of 11 cores positive, all 30%. Gleason 6. T1c. PSA 2.53  Date of biopsy 15MAY08.
Open RRP at Johns Hopkins with Dr. Partin on 09JUL08.
Pathology report:  Gleason 6, pT2, neg. margins, 0 lymph node and seminal vessical, organ confined, I lost 1 nerve bundle and 22 lymph nodes.
As of today, about a month after surgery, I feel at about 80%. Urinary control seems to be improving. Little Elvis has taken a nap and has not awakened yet. I hope when he wakes up he is well rested because he is going to get one heck of a workout.

Regular Member

Date Joined May 2008
Total Posts : 240
   Posted 8/14/2008 8:27 AM (GMT -6)   
I had the nerve-sparing surgery and both bundles were spared. We talked about it pre-surgery and my surgeon said he would save what he could, but there was always the chance that he would have to take out more that he expected. Fortunately, that was not the case. He took some lymph nodes samples and some nerve samples and had them tested. They were negative.

How many? From exactly where? I don't know.

My cancer was upgraded post-op to a Gleason 9, with a pT3a tumor. With those figures my wife has been worried sick, but the doctor said zero PSA and negative margins are all you have to know. We can't worry about what might be. We can only revel in the present.

Live on!
Age: 52
March 2006: PSA 2.5
Dec 2007:   PSA taken for insurance application. I did not see the results until late Jan '08 - after I was rejected. Their lab said PSA 4.5. PSA again in Feb '08: 3.7.
March 2008: Biopsy. Gleason 7 (4+3) 12 cores taken. 5 on the left side were cancerous and the 6th did not look good.
May 5, 2008: Da Vinci robotic laparoscopy at GW Hospital, Washington DC.
Post op: Gleason 9 (4+5). 15% of prostate involved. Stage: pT3a. Negative margins. Lymph nodes and associated glands all appear to be cancer free.

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