Does nerve sparing surgery increase ones risk for biochemical failure down the road?
In principle yes, because positive surgical margins increase the risk of recurrence and one place PSMs often occur in resecting the neurovascular bundles off the prostate (either because of undetected extra capsular extension into the NVB or iatrogenic incision through the prostate capsule into tumor) and, in principle, resecting the nerves widely could avoid these PSMs. However in practice bilateral nerve sparing (at least partial) is usually attempted unless clearly contraindicated by established risk factors.
Does removing the nerve on one side great effect my chances of ED?
Yes, at least in the short term. There is some data (www.ncbi.nlm.nih.gov/pubmed/18419221
) to suggest that in the longer term (2yrs+) the potency outcomes for unilateral sparing approach that of bilateral due to crossover innervation:
Most all surgeons (including both
open and robotic) will make on-the-fly nerve sparing decisions independently on the right and left based on what they find while they are operating. So a guy could end up with bilateral sparing, unilateral sparing or neither.
There are also degrees of partial sparing that can be done on each side. Just because you had tumor on the right, does not mean you won't be able to have at least some sparing done safely on that side.
In my case I had partial sparing on the right (where the tumor was) and maximum sparing on the left.
An MRI could be useful to help stage and pre-plan what degrees of sparing would be safe. These may be of interest:www.moffittcancercenter.com/CCJRoot/v17n4/pdf/233.pdf
Jan '13: PSA 1.23, small nodule on DRE (1st screening @ age 40)
Mar '13: Biopsy 2 of 12 cores GS 3+3: rt mid 10% and rt apex 20% w/ PNI+ Stage cT2a (confirmed by Epstein @ Hopkins)
open RRP by Dr. Burnett @ Hopkins. Both nerves spared.
Final Path: GS 3+3, organ confined (tumor extent moderate), SV and 11 nodes all negative (pT2a), clear margins!
PSA: 0.01 @ 6 wks, <0.01 @ 21 wks.
Post Edited (njs) : 10/30/2013 5:35:57 PM (GMT-6)