Newbie good morning

Welcome Hatter.   I am a radiation guy so I can't help much with surgery, but many others here can.   It looks like you have done good research and I understand both surgeons have excellent reputations.  Best advice I have is to spend the next few pre-op weeks getting in the best physical shape possible so that you are more tolerant of the surgery and hopefully have a better and quicker recovery.

Best wishes

Welcome to HW, sorry you need to be here.

Well, you've gotten over the biggest problem - selecting your treatment choice. Deciding between two top rated docs is a tough one. Objective measures might not be help so go with the one you communicate best with and one you can establish some kind of rapport with. The skill and experience of the surgery are most important but you also want one you can easily talk to.

That's my only thought.

Hang in there and keep us updated on your progress.
Andrew

Hatter,
Wow, you've got a great welcome and have done a lot to come to your decision. Since I'm a radiation guy I'm not much help. For guys that select that route, Yoop, Tud, JNF, and others subscribe to Yoop's manta of "paying it forward". Much of their assistance is behind the screens and not on this forum.

For you surgery guys, Big Mac has always offered his "down to earth" assistance. And he means it!! All the best to you..
Bill

Hopeful G9,
I went into surgery expecting my left nerve to be spared. My surgeon told me post-op they took it also. When I asked why, he told me they had decided pre-op that with my numbers it was ludicrous to leave it. I said fine. Moral of the storey I trust him. I spoke with the surgeon for 90 minutes the night before and he didn't mention it. My guess is he was thinking why add more stress when not required. I appreciated that. I think they take pride in doing what is best for their patients.
Cheers, Doug

Welcome to the board. Sounds like you've done your research and will make the decision that works best for you. I was a surgery guy and an close to 6 years post op. I was a Gleason 7 at biopsy with 6 out of 12 cores testing positive. After surgery I was upgraded to Gleason 8. I do not regret the decision I made.

Eastham and Tewari are both great urosurgeons - you can't go wrong with either. I especially like Tewari's monitoring of penile oxygenation, but my understanding is he doesn't always do that, depending on the degree of nerve sparing. If it helps, here are the questions I put together when I interviewed surgeons:

When I interviewed surgeons, my key questions were:

• How many of that technique have you performed?
• In the last year, what was your positive surgical margin rate? Among pT2? Among pT3?
• What is your "trifecta" rate?
• What kind of anastomosis technique do you use?
• Will the bladder neck be spared? How will you maximize the urethral sparing?
• Will you take frozen sections and have a pathologist standing by to determine margins and how much of neurovascular bundles can be spared?
• What measures will you take to assure the integrity of the neurovascular bundles?
• What kind of aftercare (including sexual rehab) will you provide, and how will we monitor side effects and for how long?

I also asked if he would agree to close me up if sparing the neurovascular bundles was at all problematic, or if it seemed the disease had escaped beyond the prostate, so that I could be treated with radiation instead. I couldn't find a surgeon who would agree to that :-(

In the end I decided against surgery because I was a relatively younger guy and would have more years of potential potency to struggle with impotence, if that occurred.

hatter-

Our stats are nearly identical, including our young age. Tewari did my surgery, but only after I considered many options and got lots of highly professional input from other experts. I strongly suggest you check the links below in my signature.

No matter who you use for surgery, I strongly recommend you read Dr. Mulhall's book (also linked below) and have an ED consultation with him (at MSK) before the surgery.

Mind if I ask how you were diagnosed? Guys our age are usually not screened for PCa.

I'm happy to be a resource for you either via posts on HW or via email (click the envelope icon to the left of this post).

-Gedman

Hatter,
I am 6 weeks out from my date with Robot. Uro group here in Pcola had a "Meet thr Robot" day. Got to play with a demo unit for several minutes. Very Kool. Not ready to take Uro's job with it yet.

I will be using the time before surgery to lose a few pounds and to get in better shape. Had started before dx in Feb. Now have a better reason to do so. Goal is to get to down to 265 from 280. @ 6'4, I would make a good lineman at this weight.

I read several books and read many of the posts on this forum before deciding for removal. There is a lot of support here and it helped me feel good about my decision.

Hatter, Hopeful G9, &Tall Allen,
Hatter & Hopeful G9--You guys will be fine since you both will have the best surgeons in the business! I like the way tewari thinks by getting a "read" on anything suspicious.
Tall Allen-- you "cracked me up" with your story! I've never heard of anyone who wanted to be ”sewed up" if the nerves couldn't be saved ! Almost as bad as my uninformed journey.
Bill

Thought this might help ease your mind, some, hatter... This is for pathology reports post surgery but thought it was germane to your worry about PNI.

From: drcatalona.com

8. Q: What does it mean when my pathology report after an RRP said: No cancer in the lymph nodes or seminal vessels with clean specimen margins but extensive perineural and perivascular invasion? Are these findings a reason to worry?
A: All the reports are good. Perineural invasion is present in all radical prostatectomy specimens. Small nerve fibers in the prostate gland secrete a growth factor that attracts prostate cancer cells, so when pathologists look at sections of the prostate gland, they frequently see the tumor cells surrounding the nerve fibers. This is called perineural invasion.

Perivascular invasion does not have much significance unless tumor cells are seen inside blood vessels or lymphatic channels, in which case it means there is a greater chance of recurrence of cancer and a greater likelihood that the cancer might spread to lymph nodes or distant sites.

hatter:

Another valuable tip...

Doing kegel exercises before surgery helps with continence after surgery. But, it isn't easy to know the exact muscles to focus on when doing the kegel exercises.

Some guys who still suffer from continence issues months after surgery (despite doing kegel exercises on their own) do something called "biofeedback", which helps you to learn how to focus your kegels on the correct muscles, measures the strength of your kegels, and uses gentle electrical pulses to force the muscles to contract rapidly which strengthens the muscles. The session involves putting a small probe in your backside, but really not bad at all.

My Uro suggested that I do two biofeedback sessions before surgery, to help me strengthen the muscles as much as possible to help prevent continence issues post-surgery. (Most US insurance pays for six biofeedback sessions per year, so the Uro suggested two sessions before surgery so we could save four for after surgery in case I needed it.)

I was almost completely continent as soon as the catheter was removed, and was 100% continent within a week or two afterwards. I credit that to Dr. Tewari's surgical technique and the work I did prior to surgery with biofeedback/kegels.

-Gedman

I had some ED problems after the biopsy, which was really disconcerting. But, I got some Cialis and my wife and I spent the two months having the most fun we could.

Regretfully, as the surgery got closer and I got more anxious, I honestly wasn't enjoying it as much. When you get to that point the day before your surgery, and all your brain can think is "I'll never have a normal orgasm again", it gets tough to focus on the "fun" you're supposed to be having.