I agree with James, that is the normal approach, especially from a surgical point of view. Get the cancer out, minimize incontinence, and if possible, minimize any ED issues. With surgery, of course, if you have ED, it will be right away. If you study the posts here enough, some men have nerve sparing ops and have major ED, others have one nerve bundle removed, yet have little problem. With ED however, there are many methods and paths. Recovery times vary case by case, man by man. With RT as a primary treatment, ED will happen after the fact, in some cases, long after the treatment ends.
For most of us, and its a personal choice, we want to be rid of the cancer. And you never know for sure what you are going to get out your treatment choice, regardless of what some famous doctor prints or says, its too individual to know, too many factors.
When I knew I was going for open surgery, my wife and I discussed a lot about the possiblity of me having ED and worse case, perm. ED, at nearly 36 years of marriage and a great sex life prior to PC, we both knew in our hearts, if being free of cancer meant the end of that, again, worse case thinking, then so be it.
That is a quality of life issue each person must make for themselves.
David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence: 1 Month ED: Non issue at any point post surgery
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped 9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place