Robotic nerve saving surgery for prostate removal

@jeffmarc Thank you so much for your help again. I am meeting with my urologist next week. I will ask about the PSMA PET scans as well. Do you suggest a list of specific questions I can bring to her ?

You mention "nerve saving" in the title of your post. I am not so sure if nerve saving means anything. My urologist wrote in his surgical summary report that "both neurovascular bundles were preserved" in my surgery, but I have not had even a "twitch" let alone a soft or hard erection in 11 months since my surgery. And, I just can't seem to achieve 100% urinary continence. I have been at 95-98% for about six months now, but still have those unexpected squirts, leaks, and dribbles, that see me still wearing "shields" which have now caused me skin rash and irritation from all of the synthetic materials used in their manufacturing. As an aside...I just posted yesterday that after searching for "men's cotton-lined shields", I found a women's product called Cora that uses organic cotton and no additives, colors/dyes, chlorine, etc. They feel great but they are narrow for women..."one" barely provides the coverage width that a man would need, so I am thinking of overlapping two letting the adhesive strips connect one to the other, in order to get wider coverage like a man's product offers. Anyway, preservation of my neurovascular bundles to aid in urinary continence and erections, does NOT seem to be working. Having been divorced literally one month before my RP surgery, and being as virile as a 35 year old (I was 70 at surgery), I am now dead in the water. I refuse to start dating knowing the humiliation of eventually having to say in a sexually heated moment: "sorry, but I can't perform." While a lot of women over 60 are not even interested in sex anymore, and even more over 70, I fortunately, and unfortunately, look young for my age and attract 45 - 55 year old women, who I would bet, still want an active sex life. So...I may be single and not dating for the rest of my life. I can't even imagine a relationship with a woman without sex. Ya...when I am 80 and older I guess it might be expected, but not at 71.

@christophers
Ask to have another biopsy. You need to find out what your last biopsy showed however, you still haven’t said anything about the results. It looks like your Gleason score will be higher So a biopsy makes a lot of sense.

How about logging into the medical system where you got treated and look up your biopsy and see what it shows. You could post the whole thing here and we could review it and comment

Ask to get a decipher test to find out how likely you are to have a reoccurrence. If you are very likely, then, you probably want to get ADT after treatment.

Tell the doctor you want to get a PSMA PET scan to see if the cancer has spread somewhere else in your body.

Ask, if you were to have surgery, can they spare the nerves? That’s important so that you’re able to get an erection after surgery.

Ask 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.

@jeffmarc Thank you for these. I am seeing my urologist Wednesday and will bring these questions up. Please let me know if I need to ask anything else, you have been so helpful.

@kujhawk1978 I'm 11 months post op now have tried to be patient waiting for things to return....but so far I'm being stiffed.....I mean skunked.....well nothing is working yet.
I've been trying to research things that will help bring it back. There are different pelvic floor exercise devices one sits on and supposed helps the muscle to retrain or whatever. They seem to be an expensive gamble.
It's good to hear you are doing ok now. It gives the rest of us some hope for the future of feeling someone functional again. It's been very rough.
Todd

@tmitch
The implant is highly popular with the people that have had it. If this goes on for much longer, you could get one. A few people in this forum have had It installed and like it.

@jeffmarc Here is my PRADS score from 3-29-2026.

@christophers
This refers only to a biopsy in 2021. That was a Gleason six.

You say there were biopsies in 2022 and 2024 in your original statement up above.

Do you have those biopsies? Those are really the important things because a 2021 biopsy was not really cancer needing treatment since it was a Gleason six.

I also only see PIRADS 4 Listed in this MRI. Maybe I missed the five.

@jeffmarc The PIRAD score is from the 2 MRI's I had done on 3-23-2026 and 3-29-2026. The 3-23-2026 MRI said I had a score of 5, when I went back in to confirm with a second MRI on 3-29-2026, they gave me a score of a 4.

@christophers
The area where the 3-23 Would give the PIRADS score is under impressions. That is cut off in the 3-23 MRI you posted, In the second Later MRI under impressions, it shows the PIRADS 4.

Apparently, the first clip you posted is cut off, so I can’t see the score.

Interesting that they would lower the PIRADS score In a second MRI.

The thing is the MRI is just to find out whether you need a biopsy and what really tells you what’s going on is the biopsy which you haven’t posted.