Comparing Nerve Sparing and Retzius treatments, or basic RARP ?

@fritzo Glad things seem to working out well for you.
I’ve come across similar stories of the benefit for anterior approach vs posterior more effective cancer control. What I don’t know is if location of lesion and biopsy determine which method is best.
Are you aware of any search options to help locate facility/surgeons specifically skilled in this area?
My inquiries thus far seems to require appt for consults first to than learn what they do or don’t perform

What is important to discuss is the margin cuts up to the nerve bundles. This is where discussions come up regarding how much of the bundles can be preserved. Where in close proximity the cancer is to the bundles require more cutting of margin to obtain negative margin. I would imagine you would not want him to not cut enough margin to spare more nerves than find out you have positive margin. I don’t know of the high lift approach and whether that is typical regarding nerve sparing, what is important , I would say if he is in doubt should he error on behalf to save nerves or get the cancer and if it means get the cancer take a little more margin. He gets the one shot, unless he is going to obtain real time pathology.

Since you have IDC AND Cribriform AND 7 of 10 positive AND PSA 12 - I can completely see why you want to do treatment ASAP and you are correct in your approach.

My husband was told not to rush and IMHO it was a big mistake. He had to wait 6 mos for all tests and all consultations to be done and finally had surgery but by that time he had uni-focal EPE and one margin inconclusive and his 4+3 was now 4+5 - to make the story short , biopsy is not always accurate, nor PSMA or MRI. Only when the gland is out and examined in detail all fine microscopic features are finally seen. With aggressive features it is not good to wait and try to stress that fact to your surgeon. Perhaps he can let you know when there is a cancellation opening ?

Wishing you the best of luck 🍀✨

@ireland1964 I'm gonna say this forum is a great place...perhaps start a new post asking that question.

You could also try joinging one of the support group meetings with ANCAN. It's a meeting group that really emphasiszes helping new patients navigate treatment options. They also seem to be really familiar with all the various centers in this country and in Canada.

ANCAN-Low/Intermediate PCa Men and Care Partners
https://ancan.org/series/low-intermediate-risk-prostate-cancer/
Side note: They put their meetings on Youtube, so if you want to stay anonymous, don't turn on your camera and don't use your real name...then it is only your audio that is recorded.

@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!

@fritzo Thanks Fritz and others. I have been fortunate that my RARP surgeon will meet with me again next Friday to answer more of my questions. This should hopefully help me calm down about the wait for surgery. My urologist told me that the wait time should not be a concern; problem is that that is true if upto 6 months since post biopsy, but for me, it is 8 months in addition to having some extra concerns about being “on the cusp” of intermediate unfavourable. Hopefully my RARP surgeon will understand and move up my surgery by a couple of months. I will ask him for a deeper clarification to his plans for the nerve sparing. It has taken me a long time to settle on a treatment, but I am feeling better about surgery as I don’t want QOL issues surfacing down the road from radiation, and having a clean slate post surgery for recurrence treatments, along with the prostate pathology post surgery. Thanks everyone…

@johnnyz Good work! It's so much to figure out...but you've done a great job of wrapping your head around it all. Good luck with the surgeon meeting.