Question About Nerve-Sparing

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Regular Member

Date Joined Jan 2009
Total Posts : 71
   Posted 4/20/2009 5:03 PM (GMT -6)   
I talked to my boyfriends's doctor finally today. I got the impression that he thinks the standard surgery has a better chance of sparing his nerves than the robotic surgery because they can feel around more. Supposedly, there is cancer on both sides, he is T2c and Gleason 4+4. They still have to do a bone and CAT scan to locate it. I'd appreciate hearing any opinions on the differences between the two types of surgeries as far as whether one is more likely to spare nerve damage. Thanks again for answering all my questions, this all a lot to learn about.

Veteran Member

Date Joined Apr 2008
Total Posts : 1382
   Posted 4/20/2009 5:23 PM (GMT -6)   
Thanks for the question Dana and I am sure you will get some great wisdom. From my vantage point I am not sure it matters which surgery you have as much as it matters which surgeon you choose. If the cancer is in both lobes and he is a gleason 8 please understand there is a possibilty the nerves cannot be spared. Please be supportive of that fact. These are tough life altering decisions and for the man having it done we need to feel as though we made the right decision. In the end do not second guess the outcome just offer your love and support. Please keep us posted because I will be watching to see how you two are doing. Remember Dana he needs your love and support to embark on this journey.

peace and love
My PSA at diagnosis was 16.3
age 47 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
Testosterone keeps rising, the current number is 156, up from 57 in May
T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores

Regular Member

Date Joined Jan 2009
Total Posts : 71
   Posted 4/20/2009 7:58 PM (GMT -6)   
Thanks Dale, I promise I won't ever give him doubts about his choice. I just want him to be as informed as possible, he's not one to research things like I am. I asked the doctor today how many of the operations he's done. He told me 30, but added that his boss who'll be there with him has done about 1,000. Does it really matter how many his boss did if he's only done 30? Do both of them do the operation or is the boss just supervising? I don't like doctors much and not sure I would trust him to give me a straight answer if I asked.

Bob D
Regular Member

Date Joined Mar 2008
Total Posts : 199
   Posted 4/20/2009 8:17 PM (GMT -6)   
Hi Dana,
Experience of the surgeon is the key no matter what procedure he gets.
I heard open allows a better view of what is going on. I had the
open and have healed very well as mentioned below.
Hopefully your man's is contained within the prostate and those precious
nerves can be saved. Stay positive and be strong.
    1. Age 59, psa 4.7 in Jan. 08. Biopsy: one positive sample out of 13. 1% of one sample cancer. Prostate removed on 3/5/08. Open Surgery. Northeast Georgia Medical Center, Gainesville Ga. Nerves spared. Cath out 12 days later. Continence good. No pads needed since 6/10/08. First PSA: Less than 0.1 on 6/17/08. First erection five days post op and have been improving well since then. Full erection now possible (less than four months post op) with the assistance of Cialis.  Post Op Biopsy : No malignant cells in lymph node. Gleason 3=4=7. Tumor on both lobes. Urethral margins/apex free of neoplasia. Right and left seminal vesicles free of neoplasia. No invasion of prostatic capsule of the resection margins are noted by the tumor. Tumor occupies 10 to15% of the prostate gland. Path staging T2c, NO, MX- Group staging II.  Focal areas of perineural invasion by tumor are noted. 80% natural erections and full erections with 10mg Cialis. 9/22/08-Took 10mg Cialis on Monday night, had very usable full hard erection at night, the next morning, and the following Thursday morning, 60 hours after original dose !! Orgasm quality Excellent.!!!!! I am pleased with the progress so far. Married to same wonderful woman for 39 years. She is still beautiful and sexy as ever. A great help in my recovery !!: 3/12/09: Full natural erections with penetration. 10mg Cialis makes them easier to maintain but I have had several med free full erections lately, Yipieeee !!!!!!!  3/24/09: One year PSA <0.1.  3/28 & 3/29: had sex with full naturals with no meds. Erections are gained and maintained with very little manipulation. Getting more like pre op every day.

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 4/21/2009 1:05 AM (GMT -6)   
I side with Bob on this one.
The surgeon's experience and reputation is far more important than the technique.

Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
My Journal is at Tony's Blog  

Veteran Member

Date Joined Dec 2008
Total Posts : 760
   Posted 4/21/2009 8:42 AM (GMT -6)   

If the boss is there with your surgeon, that's a big help. But will he(or she) actually be there? Maybe not, or maybe not for the whole process. You have to get a sense that you can trust them. Just in case, I hope your boyfriend is getting additional opinions.

Another important factor, besides the surgeon's experience, is the condition of the patient. Very large guys, or guys with previous abdominal surgery, may not be good candidates for robotic. If everything balances out, then robotic has a quicker recovery because there is less blood loss and less trauma to the body.

Diagnosis at age 53. PSA 2007 about 2; PSA 2008 4.3
Biopsy September 2008: 6 of 12 cores positive; Gleason 4+3 = 7
CT and Bone scan negative
Da Vinci surgery at City of Hope December 8, 2008
Radical prostatectomy and lymph node dissection
Catheter out on 7th day, replaced on 8th day, out again 14th day following negative cystogram
Pathology: pT2c; lymph nodes negative; margins involved; 41 grams, 8% involved by tumor; same Gleason 4+3=7
PSA 1/22/08 non-detectable! 8-)

Regular Member

Date Joined Jan 2009
Total Posts : 40
   Posted 4/21/2009 9:09 AM (GMT -6)   


The outcome of this surgery can dramatically affect your SO’s quality of life.  Find a surgeon with a great reputation, who has done many many surgeries.  Don't trust that the boss will help him out.  It's a one shot deal, you want to go into it with every advantage.  Experience is a big one.




Age 44, DX 12/08
Psa 2.6 free 11%
One of twelve cores pos. with 5% pc Gleason 6 3+3
RRP performed for 3/26/09 Dr. Libertino, Lahey Clinic
Post-op Path  3+3=6 pT2B, pNX, pMX

Regular Member

Date Joined Nov 2008
Total Posts : 299
   Posted 4/21/2009 9:25 AM (GMT -6)   
Davinci actually requires a surgeon and an assistant surgeon, along with other support staff.
There are anumber of videos on the web that will show the process, if you want to research. My cancer was too far along so I had to go with the open. Because I healed so quickly I don't think that Davinci would have made any difference. In the hospital two days, off pain killers the third day after surgery. I was walking 2 miles a day with a week of the surgery.
My urologist/surgeon had been Chief of Surgery for awhile so I had a great surgeon.
Age 60
PSA 2007 4.1
PSA 2008 10.0
Diagnosed April 2008
Biopsy: 6 of 12 cores positive
Gleason 4 + 5 = 9
CT and Bone Scan negative
Open surgery at Shawnee Mission Medical Center May 21, 2008
Right side nerves spared
Radical prostatectomy and lymph node dissection
Cather removed on June 3rd, totally dry on July 9th
lymph nodes negative
PSA Sept 28, 2008 0.00
PSA Jan 22, 2009 0.00

Veteran Member

Date Joined Jan 2007
Total Posts : 762
   Posted 4/21/2009 4:26 PM (GMT -6)   
Hi Dana,

You are getting some great opinions here. I try not to give opinions about these sorts of things, but your question is very relevant for us. While the robotic was possible for my husband here at the time (in Australia - although newer technique than in the US at the time), after wide reading and consultation this is the second reason, why we chose the Surgeon, the type of surgery (open) and the pathway we did. First, we wanted the best chance of living (Gleeson 7 seemed to favour complete removal rather than a 50-50 radiation method alone for us), secondly - the open surgery as presented 2 & 1/2 years ago, was what we chose for the success rate of sparing nerves. I have since learnt however, that nerves can be successfully and fully spared with the robotic surgery so we will never know, but at the time, this is what we too had heard. My husband seems to have made a complete recovery with the nerve sparing open. I think it also depends on weight. I have also since learnt (not at the time) that the robotic is less successful with men carrying weight (again not everyone certainly, reading here), however the open is recommended by some docs for this reason. My hubby does carry weight but lost it prior to operation but remained overweight at surgery but ended up with successful nerve sparing from the open. However this was not the reason at the time. This is just our experience. I agree that the skill of the surgeon - whatever the method - is the essential thing. There are podcasts etc on the both procedures and also material on nerve healing overall if you do an internet search. Lana
Husband 51 yrs (49 years at diagnosis)
PSA (2002) 2.1.  PSA (2006) 3.5.  1 x (5%) core of 12 positive at biopsy. 11 cores negative. Open Radical Prostatectomy with nerve sparing April 2007. Gleeson 3 + 4 = 7.   Undetectable PSA since Surgery (< 0.1) specifically,  
June 2007: 0.01; Oct 2007: 0.02; April 2008: 0.02: Oct 2008: 0.03:
Nov, 2008: 0.02; April 2009: 0.03 

Veteran Member

Date Joined Feb 2008
Total Posts : 655
   Posted 4/21/2009 7:30 PM (GMT -6)   
Greetings, Dana.  Everything I read prior to surgery said you want someone who has done the procedure at least 300 times.  I'm not sure I'd be comfortable with someone who has only done 30.  My wife and son are both nurses - if the other doc is not the one doing it don't count on the supervising doc being there much if any of the time.  Second, you need a doc that you both have confidence in.  If as you stated you don't trust him, I would at least look around for one that you might could trust.  Finally, I don't think the actual type of procedure is as important as the skill of the surgeon and the confidence you have in him/her (although I don't know many women prostate surgeons I'm sure they are out there).  I know of people who have had great success with robotic. I had open and have done very well.  Best wishes and keep us posted. David

Age 55
Diagnosed Dec 2007 during annual routine physical
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 positive with 2 marginal
Gleason 3 + 3 = 6
RRP 4 Feb 08
Both nerves spared
Good pathology - no margins - all encapsulated - Gleason 4 + 3 = 7
Catheter out Feb 13 - wore pad for couple of days - pad free Feb 16
Great wife and family who take very good care of me

Regular Member

Date Joined Jan 2009
Total Posts : 71
   Posted 4/21/2009 9:19 PM (GMT -6)   
Thank you everyone for the very helpful advice. Your time and caring in replying is very much appreciated. Best wishes to all.

Veteran Member

Date Joined Dec 2008
Total Posts : 760
   Posted 4/22/2009 8:54 AM (GMT -6)   
Of the two surgeons I talked to, the one who does non-robotic was a woman. Both were highly experienced, and both knew each other and were highly complimentary of each other.

Diagnosis at age 53. PSA 2007 about 2; PSA 2008 4.3
Biopsy September 2008: 6 of 12 cores positive; Gleason 4+3 = 7
CT and Bone scan negative
Da Vinci surgery at City of Hope December 8, 2008
Radical prostatectomy and lymph node dissection
Catheter out on 7th day, replaced on 8th day, out again 14th day following negative cystogram
Pathology: pT2c; lymph nodes negative; margins involved; 41 grams, 8% involved by tumor; same Gleason 4+3=7
PSA 1/22/08 non-detectable! 8-)

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