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Partial Nerve Sparing and ED

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Posted 8/26/2015 12:54 AM (GMT 0)
I was leaning toward the RP until I received news today from surgeon, I could potentially lose right NVB during RP. He said would need to evaluate based on tissue during surgery. The thought of waking up waiting for the news of having one or two nerves is upsetting.

Are there any stats on ED with partial nerve sparing?

Everyone at hospital said I am too young for radiation but I read 30% of people have positive margins and may need radiation anyway. Struggling with the downside of RP side effects if I have much lower potency odds with partial sparing.

Now I am seriously considering focal laser ablation. I was told nerves can be spared and two lesions on MRI eliminated.
Posted 8/26/2015 1:54 AM (GMT 0)
According to the data from Memorial Sloan Kettering, which has some of the top urosurgeons in the world, 33% of the men who had nerve-sparing on only one side were able to recover functional erections eventually.

Here's the study:
Erectile function recovery in patients after non-nerve sparing radical prostatectomy

Your age is not a barrier for any kind of radiation therapy. You have to talk to specialists in each kind of radiation.

I think you said you're in Boston? If so, Anthony Zietman at Mass General is a top radiation maven in the nation. Irving Kaplan at Beth Israel Deaconess gets great results with SBRT. I know there must be great brachy guys in the Boston area, but everyone I know in the northeast goes to Michael Zelefsky at Memorial Sloan Kettering. Jonathan Coleman, also at MSK, is their leading guy for focal therapy.
Posted 8/26/2015 2:04 AM (GMT 0)
Not sure where you got 33% of patients have positive margins. A good surgeon is in the single digits, I think that 33% is way off
Posted 8/26/2015 2:46 AM (GMT 0)
Here's what I want to add: Just listen to Allen, the man knows his stuff.

Andrew
Posted 8/26/2015 2:48 AM (GMT 0)
I had partial nerve sparing (took most of left side; leaving right side) two years ago. From about 3-4 months post surgery, I have had maybe 70-80% normal erections, enough to get the job done.
Posted 8/26/2015 3:13 AM (GMT 0)
Pratoman-

No one was talking about positive margins.

- Allen
Posted 8/26/2015 6:41 AM (GMT 0)
As the study mentions, age is important.

@ 42 years old...well, it's hard to keep a young man down. (I'm not lobbying for surgery for ya...just saying age can play an important role. And you've got that going for ya in spades!).
Posted 8/26/2015 6:50 AM (GMT 0)
Wolfster---In reference to what you read about these surgeries resulting in 30 percent of patients having a positive margin, you don't mention your PSA in your sig.

But, that's one for your doctor. I'd ask if he puts the odds of having a positive margin that tall. (You might just call and tell one of his staff and tell them to tell the doc you want to know what he puts the odds of a pos. margin at in cases like yours appears to be. They will/should/can get back to you with that).

That's what prato was referring to.

Post Edited (island time) : 8/26/2015 1:43:08 AM (GMT-6)

Posted 8/26/2015 10:16 AM (GMT 0)
My PSA at DX was 3.2. Pre-op PSA done in Aug was 2.31.

Thanks Edwardo for posting. Provides some hope based on study TAll Allen posted of 33%.
Posted 8/26/2015 12:04 PM (GMT 0)

Tall Allen said...
Pratoman-

No one was talking about positive margins.

- Allen

TA, I was referring to the original posters comment, 3rd paragraph in his post, where he said

"Everyone at hospital said I am too young for radiation but I read 30% of people have positive margins and may need radiation anyway. Struggling with the downside of RP side effects if I have much lower potency odds with partial sparing. "

I transposed the 30% to your post where you used 33% in reference to another issue.
Posted 8/26/2015 4:29 PM (GMT 0)
Gotcha, Pratoman. I think what Wolfster meant was there is a 30% recurrence rate after RP (rather than positive margin rate), which is true, across all risk categories. For GS4+3, T1c and PSA 2.3, there's an 85% chance that it's still organ confined.
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