Robotic nerve saving surgery for prostate removal

Have you had a biopsy yet? You really need to get that done. A PIRADS 5 Usually means cancer, but doesn’t always Mean it. Get that biopsy and find out what your Gleason score is.

You can also find out if any of these things found in the biopsy intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

You need to get a PSMA PET scan to find out if it has spread anywhere else in your body. This is critical information that is necessary to figure out what treatment you are going to have.

You could get a decipher test to find out how likely you are to have a reoccurrence.

I think you meant PSA not PSI. A PSA of 1 is very low, but some people do not produce PSA, about 10% of prostate cancer patients don’t produce it. Then again it could be you don’t have prostate cancer. You need that biopsy to find out.

They can put an implant in your penis that will give you a normal looking erection. There are people in this forum who have had them put in. It works quite well and there’s a very high satisfaction.

If you have surgery and they can spare the nerves, you may be able to get an erection without any help. You need a biopsy to figure out if that can happen.

I have worked with a lot of people who have prostate cancer and I’m aware of many different things, but you have no information to provide yet and you need that information to get help.

@jeffmarc Thank you so much for your time on the phone tonight, I appreciate it so much.

You need a biopsy to determine if it is cancer. Then added tests for how aggressive it is likely to be to decide the best treatment for the quality of life you want. For sexual function the best are the focal treatments (nanoKnife, TulsaPro, laser); however, they only work with 1 or 2 lesions confined to the prostate usually 3+4 Gleason although some will do 4+3. Failure rates are higher, but these usually extend the time you can stay on active surveillance by taking out the worst lesions. You can always have surgery and/or radiation later if there is a recurrence. Besides ED there is also a risk of incontinence from surgery. Radiation has ED risk and rectal issues that can occur several years after treatment. There is a definite tradeoff between risking quality of life and effectiveness of suppressing prostate cancer.

You could very well be sexual after RP but it might be less intense as in my experience. I had "nerve sparing" then BCR 2 years later as something was left behind. Frankly I think it is a sale tactic by the surgeon and in hindsight would rather have had WIDE margins getting all of the cancer if possible. The only good thing I can say about salvage radiation is, so far I am undetectable after 6 months. Radiation ruined my bowel and urinary continence and I leak both. Hopefully treatment works.

As I said inquiring minds want to know...

Do I have PCa?

How do I know?

If yes, what is the risk - Low, Intermediate, High...?

As @jeffmarc says, there are ways of determining that though DRE and Biopsy may not always tell the whole story.

Here's some other ways, discuss with your medical team:

Links to ways to determine if one has Pca.
https://www.medpagetoday.com/urology/prostatecancer/118778
https://www.google.com/gasearch
https://www.google.com/gasearch
https://www.google.com/gasearch
https://pmc.ncbi.nlm.nih.gov/articles/PMC4495493/
Clinical data is critical in making an informed decision whether to treat and if so, with what, for how long?

As to the nerve sparing surgery...I can relate my experience.

I had my nerve sparing surgery in 2014 at the age of 57. It took about a year for erections to return. What's different?

Orgasms are dry, no semen.
Erections require greater physical and mental stimulation to achieve

Other than that, not difference...for me. There are others on this forum who definitely do dot share my experience!

You can search for "Penile Rehab Therapy." It is a stair step methodology to regaining sexual function after surgery. UCSF has a well laid out explanation -https://urology.ucsf.edu/patient-info/adult-non-cancer/male-sexual-and-reproductive-health/erectile-dysfunction

The old adage, "look before you leap..." may apply here.

Kevin

You have excellent resources in St Louis. Seek out a second opinion from the docs at WashU/BJC.

Hi Christopher

You had biopsies in 2022 and 2024, what were the Gleason scores? You stated your PSA was only 1 How many PSA tests have you had? Is there a trend up?
A PSA of 1 is very low and as JeffMarc said puts you in the 10% club along with me as I was diagnosed at 2 PSA. Low PSA expression cancer is tricky and is often caught late. PET PMSA scans drop below 90% accuracy at 2.0 PSA and keeps dropping in accuracy on its way to .2 making results less reliable. My Urologist who is a pro radiation treatment guy (cause of the lower initial side affects) was also concerned about how well we would be able to detect reoccurrence using PSA after radiation since PSA falls slowly and might mask PC spread. I would recommend you have a discussion with your medical team about low expression PC and treatments.

Yes, listen to Jeff Marchi in particular as he's extremely knowledgeable.
I think you're jumping to conclusions about "not being able to function sexually again".
I had my RP "robotically" five months ago, and while my sexual functioning is not fully there yet--climacturia is my main problem--it is progressing and I'm still at a comparatively early stage. It's expected to take a good year for full functioning to return. I'm a decade and half your senior, and nerve sparing was indeed accomplished.
I could have opted for radiation for the same effectiveness, apparently, but was leery of all its side effects, plus didn't like the possibility of long-term effects, as opposed to immediate ones that would gradually improve.
I'm pleased that my cancer seems to have been completely removed along with the organ, as you certainly don't want any metastasis!

@sandguy I appreciate your insight and sharing your story. How much urine comes out? I never heard of this.

@jim18 @jeffmarc UPDATED 3-26-2026- I am 56 years old and I was diagnosed with prostate cancer in 2022. I had a biopsy in 2022 (Gleason level 6) and 2024 (Gleason-? I need to track down) that both confirmed cancer. I just had an MRI done this week and I got a PI‑RADS score of 5. Last year, my score was a 2. I do have prostate cancer, but my PSA levels were just checked last week and they are a 1. I am thinking about the radiation or I am considering just having my prostate removed so that cancer will not spread, but not being able to perform sexually again is scary. Is there any insight on this. I live in St. Louis, MO and I am open to hearing anything concrete of definitive and will gladly give my phone number to anyone who can help. Thank you. 314-324-3451 Chris