Hey Dave, I sent a reply earlier but AOL was acting up, so I guess it didn't go thru. I will try again & maybe if the other one shows up the Mods can delete it.
Thanks for the question because that was the "other concern" I did not have room for in my initial post.
The Non-Nerve Sparing Decision went down this way:
When I asked my surgeon if he would be sparing my nerves, he did not hesitate when he said No.
He looked me in the eye & said, "If I try to save your nerves I am afraid I will leave a positive margin,
and I do not want to give you that bad news when I get the Path report back."
I assume he based that decision on my PSA velocity of 2.1 (3 to 5.1 in a year) / 6 of 12 cores positive/ and the Gleason 8. We did no imaging to determine location of Ca in Prostate(if there is such a test routinely done)
He has a good reputation,I trusted him, I liked him, and I concurred with his decision.
I had been fighting ED because of BP meds for years. Oral ED meds were still working , but were getting less and less effective. I am 67 and had to weigh "going for a cure" v/s keeping Willy "partially" active on Oral Meds for a few more years.
The Partin Tables only had me at a 39% chance of still being Organ Contained--I think that was a big factor in my decision. I was on thin ice.
Also nerve-sparing surgery was no guarantee of good erectile function post-op.
I am sure if I had insisted on nerve-sparing, he would have reluctantly gone along. When he said he was not only going to take the nerves but he was going to take as wide a surgical margin as possible , it got my attention.
If my disease later goes systemic I wanted to be able to look back and KNOW I had done all I could.
But When the post-op Path came back with a slight downgrade to Gleason 7 (4+3) and only 20% tumor involvement, I have to admit I thought for a minute I might could have spared those nerves, but the Partin numbers are still a bad risk with a 4+3 Gleason 7. So who knows??
That was the decision process. If I had been 55 without ED from BP meds, I am sure I would have
looked at things a little different.
Having those nerves gone is not a pleasant
feeling--feels like it is not part of my body. It sucks and is depressing!!
I listed Golf, hiking, and remembering sex as my favorite past-times on my profile.
But the 1 month <0.1 PSA is real nice for now.
And knowing I have done all I can is real nice for now. I still have to worry about about BCR , Radiation and HT , but I don't have to add to my worry list that I was too passive with my initial treatment.
Any opinions are appreciated.
Best to all!
Michael F. Age 67
Dx Aug 2010
PSA went from 3 (previous 3 years) to 5.2 on annual exam. Velocity over 2 :-(
DRE pos 1 lobe
Biopsy -Bostwick Labs -6 of 12 cores Positive
1 core 2% Gleason 8
4 cores 3+4=7
1 core 3+3=6
Non-nerve sparing RALP with wide margins- Oct 2010
Post-Op Path down-graded? Different local Lab
Gleason 7 4+3 20% Tumor
Margins & nodes Clear