what are the actual stats?

Susan,

That sounds like a boastful or at least egotistical doctor to make such a claim. We have guys right here, that had purposed nerve sparing ops and still ended up with serious ED issues. If I were that potential patient, would call the doctor's bluff, and ask him if he would put that in writing, and if he turns out to be wrong, to refund all the money for the operation, and then some for damages.

That alone would make me scratch this doctor off my potential list, if I were in that situation, because I know he can not guarantee any such thing to a patient.

David

Sorry Peter, " No ED issue post surgery " is a ridiculous claim for any surgeon to make in any pre op situation, and I agree with purgatory.. grounds for dismissal. I do realize your heart was in the right place, but mitigation is proper, when it is…… well, proper.

Susan, I agree with the others, i.e. the doctor's claims...if he truly made them...are fairly outrageous. I don't have the nerve sparing vs. non-nerve sparing stats but someone else may have them. Overall ED rates for surgical patients are around 50% and around 35% for brachytherapy patients. However, the somewhat limited studies for HDR brachy are showing even better results than that.

I would recommend a thorough reading of the sticky thread at the top of our forum.

www.healingwell.com/community/default.aspx?f=35&m=2652250

Also, of course the gentleman is welcome to come here personally if he wants some interaction re his questions. BTW, I don't blame you for being somewhat outraged about this. While there are some great docs who give the straight scoop, there are way too many who leave too much unsaid...

Jim

No I did not hear this from the Dr, but it is a Dr at one of the larger well know. Hospitals in the US. I actually heard 2nd hand and I do know that when you are going through it you hear only really what you wat and almost need to hear at the time to be able to process and get through the moment and the decision. I just know what our URO told us and then hearing from so many on here since oct 2011, when I found this site. It seems more common than not that the surgeon will try to take focus off the ED. Since erections are SO important to men and how they perceive themselves I would think that male Dr would e more honest about the possibilities of issue and certainly
More upfront about the year post surgery changes.

FYI my coworker is in his early 60s and may be reading this since I did share this website with him!

Thanks for the opinions and stats this far. Venting was good for me, but I am still irate about this!

The published rate is the overall rate of top doctors in the US combined. The risk will increase for a man older than 65 or uses a less qualified doctor. This is for patients with intermediate PC.
ED 50 %
Incontinence 8%

So unless his doctor is in the top 1% he is well overstating anticipated results.

Susan,

How awful that that doctor is making promises he can't keep.

The big national study (1200 men at 9 university hospitals) about this from a couple of years ago reported that the average potency preservation rate with nerve sparing was 37% and only 13% without it. I would think some high-volume surgeons at major tertiary care facilities do better. I've heard Mulhall say that the number is around 50%, but that there is a lot of variance. Here's the report:

Prediction of Erectile Function Following Treatment for Prostate Cancer

A lot depends on how potency preservation is defined. Few men return to baseline function even at the best centers:
Is a return to baseline sexual function possible? An analysis of sexual function outcomes following laparoscopic radical prostatectomy.

Nerve-sparing is only part of the story of erectile function preservation. It's becoming clear that cutting off penile blood flow results in massive and possibly irrecoverable cell die-offs. Dr. Tewari at Weill-Cornell developed a technique where he monitors penile blood flow and avoids torsion of the nerves.

- Allen

Susan,
I actually had a doctor (one of the biggies who is often referenced here) tell me that 100% of his patients retained sexual function after surgery. It was such a ridiculous claim that I immediately dismissed him. As I think back on it, I don't know precisely how he defines 'sexual function'. At the very least, it was extremely misleading. I lost all respect for him regardless of his reputation.

There are indeed published statistics and the overall impotency rate at the 3 year post treatment point is around 50%. This holds true for either surgery or radiation..Much depends on the patients age and potency before treatment...

A 4+3=7 Gleason and a PSA of 8 usually results in fairly radical surgery which results in a higher E.D. rate than 0%........

Allen,

Do you know when Dr. Tewari started using his technique where he monitors penile blood flow and avoids torsion of the nerves? My husband had surgery with Dr. Tewari in October 2012. Dr. Tewari never mentioned this to us, but he did not discuss his surgical techniques with us.

Susan,

I am glad to hear that Michael is recovering well and will be back to work soon.

What this doctor is telling your colleague is false. Almost all men have ED after surgery and get potency back after a year or two. Dr. Mulhall, one of the top ED doctors in the country, told my husband that it takes up to 2 years to recover from ED.

I don't know if a surgeon can predict, with 100% certainty, that he can spare a patient's nerves before surgery. Has your colleague had an MRI to see if he has any extra-capsular extension?

Bluebird,

The first I read about it was in January 2012 when he reported using it on 64 men in 2008. Only patients who were continent (using no pads) and potent preoperatively, based on their Sexual Health Inventory for Men (SHIM) questionnaire scores of ≥22, were eligible for this study. I don't know whether he has expanded its use to all patients on whom he is able to do full nerve sparing, or whether he confines its use to to only those who have high degree of baseline potency as well.

Technique of traction-free nerve-sparing robotic prostatectomy: delicate tissue handling by real-time penile oxygen monitoring

Also, "nerve-sparing" is a relative term, and he has written about stratifying men according to how much of the neural hammock he was able to spare.

Anatomical grades of nerve sparing: a risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy (RARP).

He recently reported sparing the seminal vesicles on two patients. I'm glad he is looking for ways to improve robotic prostatectomies.

I've found that doctors usually take their cues from the patients about the exact details of the surgery (or radiation). When I go along on patient visits to surgeons, I always talk about details of anastomosis support and reconstruction techniques, bladder neck sparing, urethral sparing, nerve torsion, barbed sutures, etc. I sometimes find they are excited to talk about these details that they devote their professional life to. I sometimes find that they say things like, "why don't we leave those details to me." Those doctors don't get a second visit.

- Allen

Hi Susan,

As others have stated, this doctor -- if he actually DID say this -- is greatly exaggerating the statistics, which others have offered in their own posts.

I suspect that what my own doctor at Mayo Clinic told me is probably a general rule of thumb: He said that my sexual ability, after surgery, would NOT be at the same level as whatever it was prior to the surgery. I take this to mean that a man with very strong pre-op erections will eventually be able to produce strong (as opposed to "very" strong) erections after he has completely recovered.

If a man was able to have fairly hard erections before surgery, he probably will be lucky to have them hard enough for penetration.

In my own case, hard erections were rare (but not completely absent) because I was being affected by an extremely severe case of BPH. So, over 1.5 years post-op I am still waiting for consistent hard erections. So it is much as it was before surgery.

So, I guess that a guy can expect to have ability similar to, but not as good as, his ability before surgery.

So, it is probably wrong for any doctor to claim that a patient will have no ED whatsoever after surgery.

Take care,
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.
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, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.