New Poster; Advice Appreciated

OMG!
You lay out a HUGE can of worms.

First, I think you're wise to get a 2nd opinion on the biopsy. Second, despite the relatively low PSA and "intermediate" 3,4 (which could be easily be reinterpreted as a more serious 4,3) Gleason score, 12 out of 12 cores is suggestive of an advanced or aggressive cancer that needs to be treated by surgery and possibly other therapies. Third, the scope of the cancer should justify at least a CT and/or bone scan to see if and how far the cancer has expanded outside of the prostate. Fourth, a prostate surgeon with "only" a couple hundred surgeries is NOT all that experienced. Doesn't mean he can't or won't do a good job, but chances are he hasn't done enough to be fully versed in the procedure yet. Fifth, if perineural invasion (PNI) was found in the biopsy that's a clear indication of the possibility of the extension of the cancer beyond the prostate -- and suggestive of the absolute need for a CT and/or bone scan as noted above.

Here's a quote I found regarding PNI: "Since PNI is a major mechanism of prostate cancer extension from prostatic parenchyma to periprostatic soft tissue, PNI extensive enough to be sampled on needle biopsy may signal an increased likelihood of extraprostatic extension of cancer or, ultimately, of cancer recurrence." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476100/

Sixth, if your husband's cancer has extended beyond the prostate -- ED is the least of his problems. If surgery is still indicated, the surgeon will have to do a radical prostatectomy and remove all of the prostate, seminal vesicles, nerves and anything else that is cancerous. However, if the cancer is too extensive, the decision may be made to treat w/radiation and/or chemotherapy rather than surgery (since removing the prostate really won't solve the problem). Or both surgery and radiation and/or chemo may be the choice instead. It all depends on how far the cancer has spread. Seventh, blood loss from robotic surgery is supposed to be minimal BUT sh*t happens and, if the scope of the cancer involves the other structures beyond the prostate, the surgery will be more complicated and blood banking certainly would be wise. BTW, bladder cancer is very aggressive (it's a pathway to the rest of the body) and anyone who has it needs IMMEDIATE treatment. Eighth, your husband is not unlike many men who just want to cut out the cancer and get on with it, but if your husband's cancer is extensive, he may not only need surgery but also radiation and/or chemo. If he's unwilling to discuss it, he's in denial and he needs your help to acknowledge the scope of the problem and deal with it. Ninth, RUN (do not walk) your records to another physician for a 2nd opinion OR fight to get better assessment and treatment from the physicians you're dealing with now. I do not know who you should go to (because I've only been researching treatments for early stage cancer) but it should be someone with BROAD experience in treating late stage cancer who's willing to do EVERYTHING (whether it's clearly indicated or not) to diagnose and treat the cancer. Doesn't seem like your current physicians are in this category and I'm sure that others here will have some good suggestions for who to contact.

Good luck and God's speed (and BTW I'm not religious) to both you and your husband.