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Robotic nerve saving surgery for prostate removal
I am 56 years old and I was diagnosed with prostate cancer in 2022. I had a biopsy in 2022 and 2024 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 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
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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.