"Thanks...the doctor told us we needed to make the decision...because his Gleason is borderline. Leaving the nerves would make quality of life better....but is it worth taking that risk....and you are right even if they remove the nerves the cancer could still be there.
We won't know anything for sure until the prostate is removed and they have analized it.
Facing incontinece and impotence at 46 is rough (as it would be at any age) but is it worth taking a chance to spare the nerves?"
And then Swimom put it very well,
"Your hubby's PSA is still low enough and his Gleason 7 isn't in the high risk range nor are the number of positive cores, indicating the volume. A 3+4 acts more like a Gleason 6 than a Gleason 7. Unless hubby has a very small prostate or, the surgeon knows something he hasn't shared, nerve sparing surgery is not yet ruled out."
I concur with Swimom, and here's my spin. I don't believe these are either-or quality of life choices, they are shaded gray. I spoke with several surgeons, I was 3+3 in 2 cores as well when diagnosed at age 48. Your Gleason 3+4 is borderline to a 3+3 more so than a Gleason 8 or a 9. NONE of the surgeons I spoke with suggested that I had a black-and-white choice to make. Nerve-sparing surgery was on the agenda for all of them. Please note that a disproportionate number of members here are on the "more complicated" side of things... Opa, It may *seem* that the posters here don't have nerve sparing surgery, HOWEVER, having observed that, I'd venture that the majority of standard RRP or robotic RRP jobs ARE nerve sparing these days, if anyone has numbers to the contrary please educate me. It was made clear to me that the sequence echoed by Purgatory is the standard approach; remove the cancer 100%, then preserve continence, then prevent ED. My understanding is that these are all rather perversely linked components of the surgical procedure; one can have a poor tumor removal that doesn't damage the nerves and a great anastomosis, but who wants that? My chosen surgeon indicated that he'd remove the prostate and did NOT expect the nerves to be involved, but if that is what he found during the surgery, they needed to go. I was OK with that. If I recall, I signed a form to that effect, and perhaps that's the decision you're speaking of, acknowledging that it might happen, and if needed, go ahead. Real life: even if they "spare" the nerves, they get traumatized and somewhat damaged with an aggressive, careful, thorough prostatectomy. That's the way it goes. They'll need time to heal.
Also, my understanding is that surgeons have a pretty good clue about these things during the surgery. Textures, densities, colors, "stickiness", etc. Lymph node dissection & biopsy occurs while you're still in surgery. An experienced surgeon can feel and see a LOT, and more to the point, have a basis for comparison.
Look at the odds and talk to more surgeons. Check the nomograms. I believe you'd see that nerve sparing would be the approach. There's a good chance that the cancer could be wholly contained. Expect some incontinence symptoms that can be easily dealt with as things heal up. Expect some level of ED that is eminently treatable. I really don't think you're facing 100% incontinence and impotence.
Your biggest challenge appears to be interviewing surgeons to find one that you like and trust with a lot of surgeries behind them. My preference was standard, not robotic, surgery, but that's another discussion. Either way I agree with your choice of surgery rather than radiation as step one.
To paraphrase someone who posted here, I believe, some time ago; research and interview and document and review your findings diligently, you will know when you circle the trail and are not learning anything new. At that point your choice - and decision - will be clear.
Make careful notes about your journey, and make sure you're physically active to build up strength, resilience, and fitness.
Remember the larger risks in life that dwarf a prostate cancer diagnosis at an early stage. I think many of us lose sight of the big picture. Not wearing seatbelts, driving while impaired, cigarette smoking, substance abuse, inadequate sleep, obesity, high cholesterol, high blood pressure, undiagnosed diabetes, and lack of exercise will all conspire to do FAR more damage and check us out of the picture sooner than a treatable early-stage cancer. Just my opinion.
Age 48 at diagnosis and surgery
5'8", 220 lbs., overall very good health
Oct. 2007 - 4.25 PSA score from Wellness Exam at work
Dec. 2007 - 1st prostate DRE, results normal; some BPH, no infections, no other symptoms
Jan. 2008 - 4.15 PSA score, 15 Free PSA score (done before biopsy)
Jan. 2008 - biopsy done; stage T1c, Gleason 3+3 in 2 of 10 cores, one 3% and one 5%
Jan. 2008 through March 2008 - researched options, searched for surgeon, decided on standard RRP surgery
April 2008 - June 2008 took care of family, job, lawn; went fishing
June 2008 - nerve-sparing RRP. Catheter stayed in for 11 days.
--2 lymph nodes removed & tested, both fine
--adenocarcinoma confirmed, still Gleason 3+3
--tumor volume 15-20% of prostate, tumor present in both lobes
--capsular penetration, but not perforation
--clean margins & seminal vesicles
--31.6 gram prostate is gone!
--both nerves spared
--Used 39 pads over the 5 weeks following during the day, no pads & dry at night
--IC "drops" only when sneezing, lifting, or moving awkwardly during those weeks
--Went without pads starting 7-30-08 all day, saving remaining 13 pads for family gag gift
--Balance of 2008 slight IC sensations only while sneezing when lifting something awkwardly
--No continence issues throughout 2009, staying 100% dry under all circumstances!
--enjoyed most of one vial of Trimix as prescribed starting in early August 2008
--Trimix no longer really needed now (Fall of 2009) with a little help
--vial is still in fridge (nudge nudge, wink wink)
--followup PSA's at 3 mos. and 1 yr. both undetectable