question for gleason 7 or above with nerve sparing prostatectomy

i have been reading some posts regarding removing of lymp nodes during surgery and wondered how many of you had nerve sparing surgery.  also, did your surgeon discuss it with you prior to surgery.   my surgeon told me he hoped to save my nerves but never asked if i wanted them removed.   my gleason was upgraded to 8 post-op but surgeon was able to save the nerves.  I assume he could tell if they needed to be removed during surgery?   my 3 month psa was <.04 so i should be happy instead of worrying but just wondering what you all did.  still having problems on the ED issue but i know that is normal (and  may be psychological since i am thinking about the nerves!).

kcragman - if you are out there, how did your 3 month psa turn out.  your surgery date was close to mine.  hope all is well.

..mine as well, he did discuss the fact he would most probably be able to save the nerves. He also reminded once inside and looking around, so much can change, which is the main reason I went with surgery. To actually see what was going or growing inside me.....and trusted he would take care of it. We put alot of faith in those guys, they know it, we know it.....one reason it's (if not THE reason) so important to ask questions and feel comfortable with your Doc..

This is an interesting subject. I spoke to two different surgeons on my way to DiVinci (one an open surgeon and the other my DiVinci surgeon), and when I asked the question about what they could see when in surgery as far as cancer, both indicated that discerning cancer cells from other cells during surgery was next to impossible.

In my situation I was told by the surgeon going in that he would cut a wider swap (sparing some nerves but not all) because the biopsy showed cancer on both sides, and its close proximity to the prostate neck. The focus was on preventing positive margins. The surgeon said as far as nerve sparing is concerned that it is never a situation of all or none, but somewhere in between.

From what I have read of others, I am expecting the worst or at least a long road to recovery of ED. On the positive side, among the good things about being in recovery is that there is always hope. Time will tell for all of us. RB
_________________________
Age 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA .04

I had the nerve-sparing surgery and both bundles were spared. We talked about it pre-surgery and my surgeon said he would save what he could, but there was always the chance that he would have to take out more that he expected. Fortunately, that was not the case. He took some lymph nodes samples and some nerve samples and had them tested. They were negative.

How many? From exactly where? I don't know.

My cancer was upgraded post-op to a Gleason 9, with a pT3a tumor. With those figures my wife has been worried sick, but the doctor said zero PSA and negative margins are all you have to know. We can't worry about what might be. We can only revel in the present.

Live on!
kcragman