Does the surgeon have to take the nerves using Davinici when no cancer is seen during surgery?

Tall Allen said...
If there's a palpable tumor in the area of the neurovascular bundle, the surgeon obviously couldn't do nerve sparing. But what about if there is some hyperplasic tissue there and he can't easily tell? I had discussed with my urologist at UCLA a method where he takes a section from the NV bundle area and has a pathologist standing by during the operation to freeze it and examine it microscopically to check for cancer infiltration. He would make the decision based on that. I think it's a good idea to discuss this beforehand.

Here's a reference on this frozen section technique:
Intraoperative frozen section monitoring of nerve sparing radical retropubic prostatectomy.

I was able to watch about 3 minutes of the following before I started gagging:
Neurovascular Structure-adjacent Frozen-section Examination (NeuroSAFE)

I had the op some 5-1/2 years ago now. In August of 2007 the surgeon said that he would do nerve sparing surgery if at all possible but it would depend on the result of just that same frozen section (as per the clip) done during surgery. Alas tumour was at the margin of the prostate in the area of the nerves on both sides so it was decided to take a wider surgical margin given the frozen section result. Seeing that I have been undetectable at the ultrasensitive level since that time, despite the heavy prostate tumour load, it was probably a wise decision. I sometimes think that without a frozen section being done during surgery a blind commitment to sparing the nerves may involve a somewhat higher risk of later oncological failure. This may help to explain the sometimes surprising relapse of some G6s and low 7s.

Hello Cowgirl, welcome to the forum. Nobody's said that yet, have they? And we're on page two already. Sheesh. We seem to be having an off day. We're usually better than this.

All of this nerdy second guessing of the surgeon and discussions of the relative merits of different kinds of nerve-sparing techniques is fascinating, I am sure, but not, at this point, that helpful. Your boyfriend's status is what it is. His surgery is a done deal.

What we ought to be telling you is that the pumps and injections are not a scam -- they do help, and with a good relationship and a good attitude they can usually be made to work. I currently use both to keep my 'hydraulics' in working order.

There is a pretty good book by a doctor named John Mulhall that talks about what can be done for a man to continue his sex life after prostate treatments. It is called Saving Your Sex Life and is a very useful text.

Mulhall also has a couple of videos on YouTube from a lecture he did several years ago. You can watch them for free. Here they are:

youtu.be/OQlGVT7HiF8 part 1 18:33
youtu.be/o7GmTZITJ5s part 2 15:20
youtu.be/ie8NkOu2VNA part 3 31:20

If you click on my name to the left of this message it will take you to my profile page that has an email address that will reach me. I will be glad to answer any questions you might have about what your boyfriend can expect. Recovery takes time but if he doesn't get too discouraged things can be made to work again for him, somehow.

Boating and camping, eh? Both of those things are known to be GFMPH* We have opportunities coming up for both. In September there will be lots of us camping in Worried Guy's yard and in December there will be some of us on a big boat sailing out of New Orleans for Mexico.

www.healingwell.com/community/default.aspx?f=35&m=2527747 (Last year's GFMPH Yankee)

www.healingwell.com/community/default.aspx?f=35&m=2703823 (This December's Cruise)

You guys might consider going. These things are waaay more fun than you probably imagine...

*GFMPH = "Good For Men's Prostate Health

I would be very highly skeptical of any surgeon who tells me, before surgery, that he will take additional tissue without assessing the situation inside. Just take his sharp ice scream scoop and go in.
I would never submit to such an operation. I want a surgeon who says he will let the body tell him where he must go to be successful. Any other technique is excessive and covers his lack of skill.

Cowgirl,

You don't say what your man's Gleason score was, or what the percentage of cancer was in his biopsy cores. Those factors could legitimately make up a surgeon's mind about whether to spare the nerves. The fact that they did CT scans leads me to believe it may have been a more aggressive cancer. They don't usually do that for a run of the mill Gleason 6.

A more aggressive cancer, and a lot of it, would make any conscientious surgeon err on the side of caution. He may have done your man a huge favor.

I wish you and your man the best. This is not only survivable, but a good life can be had in the wake of prostate surgery -- including a good sex life. Hang in there.

Jonathan