Sorry that you have to go through this. I had several difficult months sorting things out (meetings with 3 surgeons, one radiation oncologist, and one medical oncologist) , before I settled on "Dr. DaVinci" on November 5th. My apprehension was great going in as all the surgeons I consulted (three) indicated that they would take a nerve bundle because of the location of the cancer. My experience since November 5th, however, has been better than I had hoped. No incontinence (stopped pads after three days), and I am just starting to "experiment" with the ED issue. I have learned in the past week or so that you can achieve orgasim without a full erection, which is a start after five weeks out of surgery, and a whole lot better than canned corn beef. In other words, as bad as it seems when first diagnosed, so far it has actually turned out OK. Not the way it was before, but OK and cancer free (hopefully!) is something. Best of luck.
Of all the information I reviewed while considering my course of action (and also consulting three surgeons, a radiation oncologist, and a general medical oncologist) the referenced study and article below from the New England Journal of Medicine was by far the most helpful to me.
The study followed 1200+ men and their partners for two years. Interviews were conducted before surgery, and at 2, 6, 12, and 24 months. Respondents were asked to guage their "degree of satisfaction" with "Changes in Quality of Life After Primary Care Treatment" in five areas, including Sexual Satisfaction and Urinary Incontinence. The results are graphed out nicely in Figure 1 in the article referenced below; you can keep clicking on Figure 1 it to get it to readable size.
I found the results more than interesting, and not that surprising from what I had learned anecdotally on this Board and other locations.
For example, the men undergoing Prostatectomy were divided into Nerve-Sparing and Non- Nerve Sparing groups. After two years, 40% of the Nerve-Sparing group reported they were sexually satisfied; only around 20% of the Non-Sparing group reported satisfaction. The two groups were much closer on satisfaction levels with urinary continenece, roughly 80% and 70% were satisfied.
My personal choices, because of my situation, came down to Non- Nerve Sparing Prostatectomy (one bundle removed) or a combination of Radiotherapy + NHT (hormones) for six months. Surprisingly (at least to me), the Radiotherapy + NHT group reported about the same level of sexual satisfaction as the Non- Nerve Sparing prostatactomy group (roughly 20%) after two years. That helped tilt things for me towards surgery as I decided radiation had its own problems, I was tired of dealing with enlarged prostate problems, and either way the sexual recovery part was going to be a big issue. Better for my wife and I to know before hand. The good news, for me, is that so far the continence control challenge has gone better than I could have hoped.
Well, here is the article. I found, and still find, the data fascinating if not exactly what I would have liked.
Here is the artilce from March 2008, New England Journal of Medicne.
PSA: 6.0 on 07/31/09 having risen from 4.2 on 12/02/08. Free PSA 23.5%.Other PSA History: 4.3 on 05/01/08; 3.3 on 11/15/07; 3.1 on 05/20/07; 4.0 on 11/30/06; 3.40 on 09/01/05.
Biopsy: 09/04/09 13 snips; two positive. Right Mid 4+3 = 7 and 15% of the total volume. Right Lateral Mid 4+3 = 7 and 20% of the total volume.
DaVinci robotic surgery: 11/05/09. Post surgery pathology: margins clean, no invasion of seminal vessels, no upgrade of the Gleason scores, no evidence of cancer outside the prostate capsule.
Cathether removed one week later: 11/12/09. Very minor one or two dribbles for two days. Stopped using pads after three days. No pads or incontinence at night. After years of an enlarged gland, nice to get a solid stream.
Future: first post- surgery PSA scheduled 02/02/10. That will be an important date. Hope I join the 0.00 club?