@johnnyz I'm 63, was 3+4 and my MRI / PSMA-PET scans didn't show any spread beyond the prostate. Som very similar to you.

Candidly, nerve sparing doesn't mean that you nerves aren't put into a state of shock. Even with the best of results, those nerve bundles are so fragile, the jostling around in the process of saving them will make them upset. It takes a good long time for them to settle down.

Surgeons normally say that it takes one to two years to get function back. Most happens in the first year. Some more happens in the 2nd year. Som having a nothing burger for a good long time is normal.

However, the good news is that multiple surgeons told me that majority of men after surgery will use Trimix to get ED function back. It apparently works fantastic for just about everyone. So, you are almost guaranteed that you will get a good erection....just will need a little booster shot. If that doesn't work, many patients on this forum report really happy results with an implant.

A much smaller group get full function back quickly. That's rare. I'm in a small group that has some function early, but not full yet...but improving.

There are protocols that you do to prevent fibrosis post surgery. Meaning, since you won't have nocturnal erections post surgery, they is a real risk of those spongy tissues becoming scarred from limited blood flow leading to less function. So, doing some PT for that area is key. Taking a daily 5mg of Tadalfil is standard practice for most surgery patients for this reason. But, there is a lot more you can do.

I would 100 percent arrange for a sexual function urologist for your care in a big way. I started with one post surgery and its been very helpful for navigating all of this. Some centers actually start patients doing this consult before surgery. Ask for a referral from your surgeon.

Research data has not shown a benefit of starting tadalfil before surgery, but if you do, you can figure out how your body handles the side effects. Also, you get function like a high school boy again. I say party while you can.

Side note: If you go with radiation treatment, research shows that sexual function typically does not decrease initially, but will decline over the next two years. A graph of sexual function of radiation vs. surgery intersects at the two-year mark.

I'd say, do more homework on this (search these forums-tons of info!) and don't just rely on your surgeon. Surgeons do the big cut work, but my experience is that they don't handle the recovery process as much. So, many really don't know that much about it.

Also, it sounds like with your pathology, you've got time. Make good decisions and feel good about your plan going in. It's all terrifying, but it is a slow growing cancer for most of us.

My doctor told me that my cancer was likely developing for at least 10 years. A few months is not going to change your outcome.

Good luck!