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Posted 4/30/2012 4:09 PM (GMT -5)
This question may have come up before. I asked my URO about it and he said that for high Gleason patients, removing the nerve bundles allows the surgeon to be more aggressive during surgery. What do you think?
Posted 4/30/2012 4:15 PM (GMT -5)
My uro said the same thing in a different way - he said that in order to be as aggressive as he needed to be, the nerves went by default.  There was never any premise of possible nerve-sparing for me.

And the PSA is still rising - mad

Posted 4/30/2012 7:02 PM (GMT -5)
Yep, same for me. The doctor was up front about it. Instead of a walnut sized removal I think he took a Baskin-Robbins ice cream scoop worth.
Posted 4/30/2012 8:50 PM (GMT -5)
Agreed. My uro's words"I'll be cutting a wide path just to make sure." As it turned out my Gleason 8 was downgraded, everything was contained, and I have been undetectable since. My wife says I shouldn't complain, at it was for the best . Hmm I think, maybe I wasn't as much fun as I thought I was!
Posted 4/30/2012 9:51 PM (GMT -5)
Ed C.
I made the decision to have the open cut surgery since my biopsies were so horrible that he knew that he not only needed to harvest the prostate, but would go as wide as he could on both sides. I had to give him written permission to take a nerve bundle or both nerve bundles before they wheeled me into the surgical room. He indicated that if the nerve bundles felt sticky (benefit of open vs. Davinci) he would take them out, but only if they were sticky, meaning the lovely cancer had infiltrated them. Like the previous posts, I remember being told the same thing that it was very aggressive to take out the nerve bundles but with high Gleason scores he strongly suggested letting him harvest the little guys and donate them to the landfill. What a trade off, the prospects of living longer, but giving up those "critical nerve bundles"

I hope I made the right call to give him permission to harvest them and that he made the right decision to take them out during surgery. The only thing I know, is somehow I am non-detectable one year post RRP.

PTL
Posted 4/30/2012 11:43 PM (GMT -5)
Ed,
It is logical that the more aggressive you are with a higher Gleason the better the results, hence taking the nerves if the cancer is even close is a good option.
I knew before hand that my nerves were involved and that was a major consideration for choosing radiation over surgery. So far so good with no ED or signs of a reoccurrrance.
Posted 5/1/2012 4:00 AM (GMT -5)
To my knowledge,
Some docs have stated that removing the nerve bundles is necessary when their is extra-prostatic extension that make saving the bundles difficult ~ regardless of Gleason sum. In addition, all mens physiology is different and some men have particularly difficult nerve veils to save. So there can be many reasons to do a more extensive extraction of the nerves.

But here's the kicker ~ nerve sparing radical prostatectomy is no more prone to biochemical failure rates and no study has been done to verify survival rates are improved when nerves are removed. For the guys that had their nerves removed, they have more side effects however...

Tony
Posted 5/1/2012 8:35 AM (GMT -5)
Thank you for your responses. As you know, my DX showed Gleason 8 in one and 9 in another with the possibility of EPE. Being 67 at the time of surgery, I instructed my surgeon to do whatever was needed including the removal of the nerve bundles. I'm glad I made that decision.
Posted 5/1/2012 11:44 AM (GMT -5)
My surgeon said that he would do a nerve sparing surgery if the tumor looked to be casule contained, even though I was a G 7 (4+3). Turned out I was a G8. I had a BCR one year after surgery and then had SRT. Impossible to tell if taking the nerves would had prevented BCR and SRT. I guess that I am glad to have a servicable erection after surgery and radiation.
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