Nerve sparing question

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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 12/11/2009 9:34 PM (GMT -6)   
From my reading, nerve sparing surgery helps with ED quite a bit and perhaps very slightly with incontinance?
 
Is that true?
 
Mel
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.
 
History of BPH/prostatitis.
 
PCA-3 test: 75.9 (bad news, guaranteeing I have to do....):
 
Biopsy on 11/30/09
 
Biopsy Report—Prostate Cancer

5 out of 12 positive

Gleason 4+3. More specifically:

2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:

2 cores are 4+3 (5%)--

1 core 3+4 (30%)

no peri-neural invasion

prostate is 45 grams

Stage: T1C

 Latest: Have set up an appointment at Umich with surgeon, radiation guy, general medical oncologist on Monday, 12/14. Trying to also set up appointment with Dr. Menon at Ford Hospital. Looking at another reading of the slides.


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 12/11/2009 9:50 PM (GMT -6)   
I doubt there's going to be an answer to your question(s) which applies to everyone.  The surgeon won't know what can be spared until he gets inside and then completes the surgery, and even then there's probably no 100% guarantee that the nerve bundles have been spared.  My surgeon told me all were spared but I've had incontenence and ED issues, and from what read my situation is similar to some or many other guys on this forum.  If you've done the reading on the topic(s) then you probably know as much as anyone else here.  Don't be hesitant to discuss such things with your primary care physican and then the Urologist/Surgeon - because they will know you and your health history better than we do and there may be other factors in your life which play a part in the success/failure of the surgery (when it comes to incontenence and ED).

Age:  60 (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

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

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; 9/09: 0.0

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/11/2009 9:53 PM (GMT -6)   
Never heard of nerve sparing operations helping with incontinence. As far as ED, that is one of the main selling points, sometimes it does help a lot, and sometimes it doesn't seem to help at all. Even when both nerve bundles are spared, they are still so traumatized from surgery that it takes a real long time for them to heal.

We have men here two years out of surgery with nerve sparing surgeries with total ED, and others that had little or no trouble at all.
We have men with one side spared that had no ED, I am in that small group.

I think what you have learned most here is how arbitary and inconsistent PC is. If you are looking for any absolutes or any logic, its the wrong kind of cancer or disease. I dont say any of this to be discouraging, but I think its important that you accept that.

Until you go through whatever primary treatment you decide, and start the recovery process, there is no way of really knowing what you will face personally.

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, Cath #9 in 35 days, 12/7/9 - Cath #10 in place


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 12/12/2009 7:45 AM (GMT -6)   
Compiler, my husband had nerve-sparing and is still struggling with ED 20 months post-op. Again, there is no one size fits all scenario. Surgery aims to remove the cancer from your body, and radiation aims to kill it off. Both treatments are powerful weapons, and each has an important place in treating prostate cancer. But, you there is simply no way of knowing - or even guessing - how you will react to either treatment.

Hopefully you will get some answers from your meetings this week.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4 SA. PSA: 0.0 til July 2009. August 2009 PSA was 0.1, in September it was 0.3 Met with radiation oncologist, CT scan and bone scan clean. Third PSA on October 16 - PSA BACK TO UNDETECTABLE! Next PSA scheduled for early December. No radiation treatment at this time!


kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 12/12/2009 7:53 AM (GMT -6)   
My understanding is the nerves that are mentioned are only for erectile function. But, I may be wrong!
KW
    43 at Dx and Surgery (RRP)
    PSA 5.7, Biopsy 3 of 12 positive (up to 75%) all on left side of prostate, Gleason 7
    RRP on Oct. 17, 2006 - Nerves on right side saved. All Lab's clear. 
    Cathiter in for 28 days due to complications in healing. Removed Nov. 9, 2006
     Dec. 2006 – Oct. 2008 Cystoscope, Two Collagen injections,Second Opinion   
    Consultation for Incontinance at OU Medical Center, Bio-Feedback       
    training, Chiropractic, Accupuncture , AdVance Male Sling, Two More Collagen 
    injections, AUS Installed and Activated (Dr. Morey at UT Southwestern Dallas TX)
    All to try to resolve incontinence (using 6-8 Depends Guards a day)

    To Date All PSA's 0.00.

   http://www.healingwell.com/community/default.aspx?f=35&m=721171

    http://www.healingwell.com/community/default.aspx?f=35&m=978691


lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 12/12/2009 8:20 AM (GMT -6)   
Compiler.
I think the skill of the surgeon performing the nerve sparing also helps with the erection capability post surgery. I went with a top notch surgeon at Vanderbilt. He spared 100% nerves on the one side and only 50 - 70% on the opposite side in his opinion due to the cancer. I'm 4 months post surgery today and able to get usable erections with the help of Levitra. Nothing like pre surgery but better then zilch. There are just so many factors that play into the recovery of sexual and urine control I don't believe that there is a definite answer to your question.

Larry
Age 55 / age at diagnosis 54, PSA 5.1
Robotic surgery 08/12/09 at Vanderbilt, Nashville TN. 
Final Path report:
20% of the prostate Invovled
Tumor graded at T2C
Overall Gleason 3+4 (7)
Lymph Glands Clear, Positive Margin Noted in Right Apex
 
First post Surgery PSA - 0


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 12/12/2009 9:28 AM (GMT -6)   

I’m with David. I had informed knowledge that I was going to lose my neuro/vascular bundle on the right side because of the volume of cancer. I was completely in agreement. I may be incorrect here but I think it is important to remember that we are talking about a neuro/vascular complex not just nerves. I also agree about the incontinent issue not being so much related to the “nerve sparing” issue. However it does make some since that the more extensive the surgery is in the amount of tissue that is disrupted the more likely to have all kinds of additional complications. I only hope that the technology and operative procedures continue to advance to mitigate these things. Oh heck I hope medical advancements take the need for surgery or nuking the heck out of yourself off the pick list for approved intervention therapy. Good luck to all.

jnm


Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. 75% of one core.
da Vinci at Wash U, Barnes on 11/02/09
Pathology Changed Gleason to 4 + 3 = 7. Gleason 7 present in all 4 quadrants
All(4)periprostatic Lymph Nodes Negative, All(10)pelvic Lymph Nodes negative
Seminal Vesicles tumor free. No prostate extension


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4123
   Posted 12/12/2009 5:00 PM (GMT -6)   
I questioned my Uro about just the ED part with Nerve sparing, which he told me I was spared.... His quote "Its a crap shoot. Some get wood back others don't" That is as much as he could say. Im 14 months out from surgery and still not there. I hope that this New Year will bring me success with injections 1st wk in Jan. Appointment is already made.

Best of luck.

Jeff T
Jeff T Age 57

9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/12/2009 6:21 PM (GMT -6)   
In the 13 months since I had my open surgery, my uro/surgeon and I have talked about many thing including the whole subject of nerve sparing operations. He rarely does them himself, even though he is very experienced and accomplished. He values the importance of being able to have errections as much as the next guy, but his primary goal, is to eradicate cancer. He said even in the nerve sparing ops, they have to "shave" so close to the nerve bundles, that they effectively may be severed. Plus he said the nerves we are talking about are so tiny, that its kind of hit and miss on the best of days.

He still thinks my natural ability to have errections and not to experience any ED after surgery with just one bundle left behind is a freak thing. He still won't take surgical credit for it. He said, I should be having problems, but also stated that each "body" is so uniquely different than the next.

My point, I think the nerve=sparing aspect is something that is oversold. No doctor can guarantty results even if you choose to go that route. There are other factors involved.

My own surgeons expertise is on the Incontinence front, he said that is where good surgery can make a big difference. While he has no objection to robotic surgery, they do it at his practice, he is 100% and open surgery surgeon. He said he can make a good argument for the tactile feel case over the increased magnification advantage of robotic. I am sure this is something that surgeons hash over in their spare time. He said an experienced surgeon can feel things with his fingertips and that its just not the same with robotic probes. That may be subjective, as none of us are surgeons.

Just thought i would share his thoughts on the subject

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, Cath #9 in 35 days, 12/7/9 - Cath #10 in place


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3743
   Posted 12/12/2009 6:33 PM (GMT -6)   
Mel,
Look at the results of the study tha has been bounced around in several of your posts already.
There were curves with data on several thousand men. One graph showed three lines: 2 nerves spared, 1 spared and zero. Of course 2 nerves spared was better but there was surprisingly little difference between the three curves. i believe the x axis was time and y was incontinence. There were also results for ED. I'll leave it to you to find it.
Good luck,
Jeff

MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 12/13/2009 2:03 PM (GMT -6)   
Hi Mel,

Nerve sparing has nothing to do with Incontinence

My Surgeon told me that nerves are funny, even if spared they are moved and stretched quite a bit. Just because he was technically able to tell me he spared both that did not mean there was any indication the ED would not be a problem. He mentioned a select few patients that had only one spared yet had far far less ED related issues than most that had both spared

It all depends on the patients healing ability
Stats:
Age: 52
PSA (2008)=1.9
Biopsy on Jan 09, 2009
One (1) out of twelve (12) cores was positive, plus external nodule found
Gleason Score = 3+3
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, under .0


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 12/13/2009 2:29 PM (GMT -6)   
MrGimpy is right, I think. I was nerve spared also, but my 2 uro's since have speculated that due to the enormous size of my prostate (110 gms) the nerves were already stretched (I had already begun to experience some ED problems before diagnosis) and they may have been much more easily damaged than normal, because they were stretched and may have been 'thinner' because of it. In any casse, I am 27 months and have zero response since before surgery, so it makes sense, I suppose. Whether they will ever repair and start working, if you buy into that explanation, remains to be seen. sad smilewinkgrin
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, Bimix .3ml PRN or Trimix .15ml PRN

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