The primary concern should be dealing best with the cancer, how to remove it, treat it, etc., and I believe concerns about ED or incontenence shouldn't play a part in the treatment decision. Do we want to live a longer and better life, or live a lesser number of days, pee better and have more sex? The answer to the questions become simple when you prioritize the matter . . . at least that was how I felt at the time I was confronted with the "news."
A good primary care physician, someone who you've been visiting over time, who does your physicals and knows your health history, your lifestyle, etc., is so essential a figure/influence at this particular time that it's important to focus on that relationship - a relationship that should allow the primary care physician to lead you through the myriad of options.
I don't think it's fair or accurate for an impression to be created that there are physicians/urologists/surgeons who will talk you into a course of treatment that's not in your best interest . . . because it happens to be their personal and practice specialty. That's a very cynical view of things - and so is suggesting a physician will steer you to a course of treatment because he or his practice will earn greater profit from doing that.
The primary care physician should be acting as sort of a referee in the process - explaining things as they go along and helping you make the choice you're most comfortable with. Independently bouncing from one specialist to another without someone such as a primary care physician coordinating the process creates the opportunity for increased risks and an eventual decision which may not be what you really want to or need to do in your particular case.
Because the body and health history of each of us is different, there are often compelling reasons to choose one course of treatment over another - trumping the argument about the "skill of the surgeon" being the primary factor to consider. There are men for whom the open surgery is the best, for others da Vinci and for others non-surgical treatments. Nobody here can say which is right for you.
And I think the suggestion, posted above by someone else, that da Vinci surgery costs approx. $55,000 more than open surgery and that most insurance companies won't pay for the procedure are not factual statements. I know that in my situation Blue Cross paid every penny.
This is a good forum to read and participate in, but it's the medical professionals you should be having these discussions with.
Age: 59 (58 at diagnosis - June, 2008)
April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior
June '08 had biopsy, 2 days later told results positive but in less than 1% of sample
Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days
Dr. recommended robotic removal using da Vinci
Northwestern Memorial Hospital, Chicago, IL
Dr. Robert Nadler, Urologist/Surgeon
Post-op Gleason's: 3+3, Tertiary 4
Bladder & Urethral: Free
Seminal vesicles: Not involved
Lymphatic/Vascular Invasion: Not involved
Tumor: T2c; Location: Bilateral; Volume: 20%
Catheter: Removed 12-days after surgery
Incontinent: Yes (1/2 light pads per day)
Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08
Returned to work 9-29-08 (18-19 days post-op)
PSA test result, post-op, 10/08: 0.0; 12/08: 0.0; 4/09: 0.0