Would gleason score warrent non-nerve sparing surgery?

Hi,

My BF had a non-nerve sparing surgery? The surgeon said there was no choice to save the nerves. The reason given was his gleason score. Before surgery his gleason score was a 7 and staged at T1c. After the surgery his gleason score was 8 and he was staged at T2c.

So, does a gleason score warrent the surgeon to not save the nerves?

Thanks!

Sure can. Mine was a G9, 5+4, and the urologist said he would have to do a "wide excision" and couldn't do luxury things like nerve sparing. My staging was more advanced at cT3a too, with evidence of neurovascular bundle involvement (by MRI). The planned surgical aggressiveness and limited chance of success was one big reason I went with radiation therapy.

Gleason 8-10 scores have similar risks according to various studies, though presence of any type 5 cells is usually a worse indication. The increasingly degraded state of the cells makes them more likely to survive outside the prostate, so increased recurrence risk.

The urologists make some on-the-fly calls during the surgery too. Prescreening info tells them a lot, but once they're in there with eyes (and possibly hands) on the actual tissues they adjust their plan as they see appropriate.

Hello Cowgirl,

Good to hear from you again. I hope the holiday season is treating you well.

I have two answers to your question: The first is yes, a high Gleason score can justify treatment even if the location of the cancer precludes nerve sparing.

The second answer, and more to the point, is why are you asking? Unless you are looking to sue his surgeon that boat has sailed and there isn't much to be accomplished by second-guessing choices already made.

Tell us how he is doing and we can help find a way forward, because there is no going back.

I am not looking to take anyone to court. I just need more information to ease my mind. I couldn't find anything on the Web, so that is why I ask here at Healing Well.

My BF had surgery 4/18/13. I think that I keep asking these questions because my BF isn't doing any physical therapy. I finally got him to start using the pump starting in August. I think he stopped using it in September because he said it hurts. He won't do muse or injections. I just feel like intamacy is never going to happen again as long as I stay with him. I was so depressed that my doctor perscribed me depression medicine. It has helped my depression. I have went to see a counslor, but I can't seem get over what this disease has done to our relationship. I just don't know if friendship is enough for me.

cowgirl53 said...
Hi,
My BF had a non-nerve sparing surgery? The surgeon said there was no choice to save the nerves. The reason given was his gleason score. Before surgery his gleason score was a 7 and staged at T1c. After the surgery his gleason score was 8 and he was staged at T2c.
So, does a gleason score warrent the surgeon to not save the nerves?
Thanks!

I could be wrong -- because it certainly does depend on what the surgeon sees during the actual operation -- but a T2C is an organ confined prostate cancer. So, basically, I see no reason why both nerves had to be removed.

While the post-op Gleason score did reveal a more aggressive type of PC than predicted by the biopsy (this happens in about 25% of PC cases) the post-op staging still suggests that the cancer never left the prostate.

In such a case, my guess would be that the post-op report said there was no involvement of the seminal vesicles, extraprostatic tissue, lymph nodes, etc.

So my highly uneducated guess would be that neither nerve needed to be removed. As I said, however, my guess is not that of a trained medical professional. I'm just going by the definition of the staging.

For example, my own case was T2C even though there never was any lump felt on the prostate via DRE. Just the fact that the tumor involved both lobes was enough for the Mayo urologists to say it was T2C. But according to the definition, a T2 staging would mean a palpable tumor (meaning it could be felt on DRE).

So, perhaps his tumor WAS palpable and the surgeon felt that the nerves on both sides needed to be removed as a precaution? Only the surgeon could answer that.

I hope that his sexual appetite returns for you, though. Maybe as time goes on, his natural urges & desires will begin to return.

Good luck!
Chuck :)

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Pathology showed Gleason 3 + 3, pT2c, N0, MX, R1
adenocarcinoma of the prostate.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, 9/9/13 PSA <0.1. PSA tests now annual.
Semi-firm to firm erections now happening 2 years post-op.

Cowgirl,

After I had my biopsy my urologist said that he always tries to perform nerve sparing surgery, unless it increases the risk of the cancer spreading. Even saying that he went on to say that many times it isn't physically possible to save one or both nerve branches since they can't be peeled away from the prostate. In my case both nerve branches were saved. Bottom line is to guarantee the likelihood for the most successful removal of the cancer.

In very simplistic terms, prostate surgery in some ways like a contractor remodeling a house, you really don't know what you are getting into until you open everything up. What might seem like an easy job turns into a nightmare when one finds shoddy workmanship, improper construction and damaged materials that have to be replaced.

Is your boyfriend continent? If not that might might be one of the issues on being intimate.

I was a G4+3 and G4+4 in 9 of 12 cores of the biopsy. The surgeon said there was little or no hope of sparing nerves. They did an "on the spot" exam of tissues removed in the OR, and the pathologist did not like what he saw, so they went back in and took everything they could.

The decision of the surgeon was correct, as I came out G4+5 in 40% of the gland, and EPE on all sides.

I went in with a bit of blind, baseless hope, but was sure the nerves were gone. No other way to approach it. If you go in thinking miracles will happen, those hopes will almost always be crushed. I got what I expected, learned to use Trimix, and except for my spell on Lupron, that stuff rocks!!

Cowgirl,
At my initial consult with an uro who I'd just met, I was told that I had "high risk" prostare cancer (no stage or g# was provided) and that she would take my " nerves" and would also excise wider which would leave me permanently incontinent. She was disappointed when I told her "no" and not to work me into her surgery schedule. She was perturbed and offered me "hormones" which should last me a few years. When I asked about radiation I was informed that "they didn't do that there".
I thanked her (maybe) and informed her I'd have my local HMO handle it.. At my age and with my ego QOL was the most important thing to me..I've always wondered if the uro attempted "nerve preservation" in any of her patients; I'll never know.
Regarding your situation, a discussion with your boyfriend is urgently required; as 142 mentioned, sex is possible but different. Your decision to make and a councilor should be involved but from your report it may not happen! All the best but not a good situation.
Bill