All good points. I would summarize my concerns and comments as follows:
1) Preserving the ability to produce semen should be low in priority. Quality of life issues should take high importance in treatment selection, however in general the ability to ejaculate does not affect quality of life. Certainly, there is a bit of a sense of loss and being "different", but I have found this to be minor.
2) Being treated for PCa is serious stuff, regardless of the treatment. Even if there is a "Plan B" were a chosen treatment to fail, the risk of this should not be taken lightly. Even with the recent study and popular news about "overtreatment", how many men on this forum would think they have been "overtreated"?
3) In all honesty, I am somewhat of fanboy of robotic surgery. In my particular case, I had an amazing recovery, which I attribute to my relatively young age, one of the best PCa surgeons in the world, and luck. I guess I might feel different had the outcome not been as good.
Age:45 (44 when diagnosed)
Father diagnosed and cured at age 52.
08/21/07: Diagnosed with T1c cancer
1 of 12 biopsy cores positive; 10% tissue
Gleason score: 3+3=6
PSA level prior to biopsy: 4.3 (velocity < 0.4ng/ml)
10/19/07: da Vinci prostatectomy by Dr. Vipul Patel
Difficult surgery due to prostate inflammation.
Both nerve bundles spared.
Spongy erections began within 24hrs of surgery!
10/24/07: Catheter out; down to 1 Serenity pad/day next day.
Final pathology: neg margins, no capsular penetration,
Gleason 3+3=6, 5% tumor involvement, multi-focal.
11/04/07 First usable erection with Cialis
11/22/07 Thanksgiving - Bye-bye, pads
01/17/08 First post-surgery PSA result: < 0.008 ng/ml
03/17/08 Erection quality mostly back to pre-surgery levels with Cialis;
have not tried without meds yet.
04/23/08 Second post-surgery PSA result: < 0.008 ng/ml
07/30/08 Third PSA: 0.01 ng/ml
11/04/08 One year PSA: 0.01
Still taking 10mg Cialis every other day - enjoying the results
too much to stop yet.
02/07/09 Taking 5mg Cialis every other day - having too much fun to try
to stop for now.
03/23/09 PSA: 0.02