Robotic nerve saving surgery for prostate removal

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

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.

@chippydoo @kujhawk1978 @jeffmarc
Does the removal of the prostate carry a chance of bowel/urine leakage? Are the PI‑RADS scores accurate? How can they differ that much from my PSA score of 1? I am going to ask my urologist about getting this group of tests. Is it as simple as just asking for these tests? I wonder why she wouldn't have suggested them already?

4K score test
PHI (prostate health index)
The EpiSwitch® Prostate Cancer Detection (PSE) test
Multiparametric-MRI in diagnosis of 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.

@chippydoo @kujhawk1978 @jeffmarc
Does the removal of the prostate carry a chance of bowel/urine leakage? Are the PI‑RADS scores accurate? How can they differ that much from my PSA score of 1? I am going to ask my urologist about getting this group of tests. Is it as simple as just asking for these tests? I wonder why she wouldn't have suggested them already?

4K score test
PHI (prostate health index)
The EpiSwitch® Prostate Cancer Detection (PSE) test
Multiparametric-MRI in diagnosis of prostate cancer

@chippydoo @kujhawk1978 @jeffmarc
Does the removal of the prostate carry a chance of bowel/urine leakage? Are the PI‑RADS scores accurate? How can they differ that much from my PSA score of 1? I am going to ask my urologist about getting this group of tests. Is it as simple as just asking for these tests? I wonder why she wouldn't have suggested them already?

4K score test
PHI (prostate health index)
The EpiSwitch® Prostate Cancer Detection (PSE) test
Multiparametric-MRI in diagnosis of prostate cancer

@christophers
Some people who have their prostate removed, have a real problem with Incontinence. About 10% of people have no problem at all, I was one of them. For most people it’s just lasts for a few months. For some it goes on for a year or more.

You should be doing Kegel exercises before surgery to try to strengthen the Pelvic floor, And do the same thing after surgery as soon as it’s safe according to your doctor. You can also see a physical therapist who specializes in pelvic floor exercises.

Bowel problems are pretty much not an issue.

You can get your MRI reviewed by another company, but the PIRADS Scores are Usually very reliable. Even if it was a four, you would need a biopsy to find out if the cancer was a higher Gleason score.

The PSE test is probably unnecessary. You said they found cancer in your biopsy last year. Were you able to get a hold of that biopsy and see what it said your Gleason score was? If that test definitely found cancer the PSE test is not necessary. It is used to decide whether there is Cancer in your system, And if there is then you get a biopsy. In your case, you need a biopsy because of the MRI results.

Another MRI makes no sense. A biopsy is what you need after the MRI you just had.

You can get a 4K score or PHI test But it is designed to find out whether or not you need a biopsy, Your MRI says you do. The PSE test is much more accurate. I’ll include a photo of all the tests that are used for cancer screening, But you are beyond the need of a screening test.

You’re better off getting a decipher test to find out what your chance of reoccurrence is.

@christophers

Does surgery result in urine leakage...?

Answer, it can. Then again, when my catheter came out after surgery, zero incontinence and to be honest, I didn't do any Hegel exercise before or after!

Urinary incontinence is a common, usually temporary side effect of prostate removal(radical prostatectomy), with most men regaining control within 3–12 months. It results from damage to nerves or muscles controlling the urinary sphincter during surgery, leading to involuntary urine leakage, primarily through stress or urge incontinence, which may require pads or specialized exercises to manage.
Key Types of Incontinence After Prostate Removal
• Stress Incontinence (Most Common): Leakage occurs during physical activity, such as coughing, sneezing, lifting, or laughing, due to weakened muscles supporting the urethra.
• Urge Incontinence: A sudden, uncontrollable need to urinate, often caused by bladder spasms.
• Continuous Leakage: A severe, less common form where urine leaks constantly.
Causes and Factors
• Damage to Sphincter/Nerves: The prostate wraps around the urethra, and its removal can damage the external sphincter muscle and surrounding nerves, which are critical for holding urine.
• Shortened Urethra: The urethra is slightly shortened during the reattachment process.
• Healing Process: Swelling or damage from surgery disrupts normal bladder function.
Recovery and Management
• Timeline: While most men see improvement in 3–6 months, some may take up to a year or more to regain continence.
• Pelvic Floor Exercises (Kegels): These are essential to strengthen the remaining muscles to take over the role of the sphincter.
• Prognosis: Approximately 10–15% of men report frequent leakage or the need for pads 6 months after surgery.
Long-Term Complications
• Permanent Incontinence: In rare cases (roughly 5-8% of men), incontinence can be permanent or last longer than a year.
• Urethral Strictures: Scar tissue may cause a narrowing of the urethra months or years later, which can alter urine flow and cause new incontinence issues.
• Surgical Interventions: If conservative methods fail, options include artificial urinary sphincters or male slings.

Bowel leakage...? I don't have the experience or layman's degree of expertise to say.

Ditto for the PI- RADS

As to the tests, that depends too. Some medical professionals are slow to adapt to changes brought about by medical research.
There may be insurance issues.
There may be a concern that those tests are not necessary or "over testing."

Do your homework on these tests so you "understand" them.

Consider sending a note through your patient portal saying these are the things you would like to talk about at your next consult, specifically, will these tests help answer the question:

Do I have PCa?
Is there clinical data sufficient to determine if we need to consider treatment?

Kevin

@jeffmarc Thank you, I am getting a confirmatory MRI next week and more blood tests. I just am at a loss to know why my PSA score of 1 would show up. So much information to gather here.