Here is my background which may help in the decision process: I was diagnosed at age 61 with Gleason 6 (3+3) with genetic testing showing it as slow growth with 2 cores less than 15% on biopsy, PSA at 4.6 At age 67 after 6 years of active surveillance (checks every 6 months with one or more of the following: PSA, MRI, DRE, MRI/Ultrasound guided biopsy, etc. on a periodic basis), still at Gleason 6 but with rising PSA to over 10.5 and biopsy with 4 cores less than 15%, I had my prostate removed using never sparing single port robotic surgery. Pathology showed I was at Gleason 7 (3+4) so the timing for removal was on target.

Unfortunately severe incontinence and ED resulted (main reason I originally opted for active surveillance as long as safe) which was a surprise since I was in excellent shape and a great surgery candidate. The surprise was how severe each was since it is expected nearly 100% for some period of time. After 10 months of pelvic floor, mybetriq bladder medication, physical therapy, etc. I opted for an Artificial Urinary Sphincter (AUS - Boston Scientific) surgery to resolve 4 - 6 maximum pads per day for leakage. Now I'm down to 0 max pads and just one very light pad per day for a few drips, so a big success. Since I was beyond 3 max pads per day, the less intrusive Sling surgery option wasn't feasible.

On now to tackle the severe ED issue. Medications have no impact, vacuum device used for penile rehab is not really feasible/desirable so I opted for a stem cell injection a few weeks ago and am waiting to see if there is any impact by the 3 month mark. If not I may then try Trimex injections. Hopefully one of those will work since the last resort would be a penile implant, which I rather not have to do.

Any advice on the ED issue would be appreciated. If I can help in the decision process for active surveillance, prostate surgery or incontinence with AUS, please contact me.