Points To Consider Here:
(1) Davinci Surgery is no better than open surgery in terms of long term outcomes for incontinence and impotency. In fact studies show that Davinci patients have a much higher dissatisfaction with outcomes than those who have open surgery or radiation but that's because the Davinci video leads you to believe everything will be *** dory and back to normal after this simple procedure. Wrong! Lots of men with bilateral nerve sparing surgeries will still have issues with incontinence and impotency. Still, as of 09/11/08 in my area Davinci Surgery was a faster recovery: open- 3-4 days in hospital, catheter in 2 weeks, go back to work after one month from catheter removal, DaVinci- 1 night in hospital, catheter in 8 days, I went back to work 3 days after catheter came out. If you are rich or retired this doesn't mean much to you but I am 52, wife doesn't work, I am a poor guy, can't afford to be away from work for a month, no AFLAC duck at my job, needed to get back to work ASAP. Also, my local urologist was the "king" of the open surgery, but I really didn't trust him even though I had gone to him for yearly PSA's and DRE's for 17 years. Every year I would have to blow a half a day of work for my annual visit, he was always coming late from surgery to see his patients, appointments meant nothing to him. Whether you had a 830,930,1030 appointment he never showed up til after 1100 year after year. I felt he was in it only for the money. I mean we all want to make money but my time is valuable too. The final deciding factor against using the local "king" versus going out of town for Davinci was the "king's" physician assistant telling me what he would do after I had my second prostate biopsy which turned out to be cancerous. And I quote "Oh I would never have a robot operate on me. Dr. "King" has done thousands of open prostatecomies. He is so good at it that he can knock one out in less than an hour." Well I am glad he can do 8 prostatectomies/day but what about trying to save my nerves so I can have some kind of normal life?
(2) The more experience with either surgery (if you choose surgery) the better. Again I am a poor guy, the best I could do was go to a town 70 miles away from my town of 500,000 (where nobody does Davinci) and find the guy with the most Davinci experience, which was over 300 surgeries. If I had been a RICH GUY I would have gone to somebody who had done a whole lot more of these surgeries, like Randy Fagin in Austin, or maybe somebody in Houston or New York. Some of these guys have done over a thousand of these surgeries.
(3) Most guys after surgery will have incontinence and impotency, the question is for how long? My incontinence was gone in 3 months, my ED remains after 6 months out. I am still using trimix injections for sex, but things are better, I am using 1/2 the dosage I use to use for a good erection and there is some signs now of spontanteous erections. I hope to get by with the oral pills some day. Guys who go for radiation, proton therapy, HIFU, cryo seem to have much lower rates of incontinence and impotency at least initally. 3 years out the rate of impotency for surgery versus radiation seems to be about the same.
(4)If you do radiation first and your PSA starts to rise salvage prostatectomy is a real mess. There are major complications like fistulas and repeat repair surgeries. Usually you have to go on to anti-hormonal therapy and if that fails chemotherapy.
(5)For guys with low Gleason scores, 6 or less, and low cancer volumes doing nothing (watchful waiting) and havng repeat PSA"s and biopsies is an option since these types of cancers grow slowly and may never cause a problem. I was too paranoid for this option, both of my parents died of cancer, I had to get it out, but that is just me. Good luck on your decision!