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Best treatment for sparing nerves

Posts: 66
Joined: Feb 2013

Is robotic surgery the best hope for sparing nerves?  Does radiation nuke the nerves along with the prostate?

VascodaGama's picture
Posts: 3371
Joined: Nov 2010

The best hope for a successful RP with nerve spare technique is at the hands of the surgeon, independently of the type of surgery; open or robotic. Look for someone with loads of experience.
Radiation also affects to certain extent the nerves evolving the prostate gland but they will be “there” after the treatment instead of RP where the risk is for permanent damage.

Hope for the best.

Best wishes for 2014


Posts: 32
Joined: Feb 2011

In one week it will be 3 years since my RP operation. Right now I struggle that I made the wrong dission. When I was told and it was confirmed that I had prostate cancer I decided on RP (particaly convinced by my wife to totally get the cancer out of my body) I did my research and find one of the best cancer hospials in my area. I was very confortable that the surgeon who was going to operate on me was the chief of surgery in the urogoly department, had a great reputation and who had done many many nerve sparing operations.

Well, my psa was been zero so far...will know next week if it still is. I had and still do not have any leaking problems. So what's my problem? Till this day I still cannot get an erection after 3 years and "nerve sparing"surgery by one of the best doctors. Although I am 71 years old my wife and I did have somewhat of a sex life. I have tried all 3 types of pills, with no luck. Can't see myself doing injections or any kind of implants at my age. My yearly appoinpment is next week...any advise? Think I should have done a differant procedure.

PawPaw J
Posts: 34
Joined: Jul 2011

BOB, I am in a similar situation as you. I will be post surgery for 2 1/2 years in February. Unfortunately the urologist in my area do not use the sensitive psa after the first 6 months after surgery so all I know is my psa is less than 0.1. I was dead set on the surgery to get it out of me. I didnt really look into any other treatments as I thought this was the best chance to rid my body of the cancer. My mentality was that as long as I beat the cancer, ED would be tolerable to deal with. Thankfully I never had any incontinance but as of this day I can barely get an erection that is usuable. I have tried the pills and also dont want to get into the injections. Even though I get satisfied it does nothing for my wife and after this long it has become more frustrating and humiliating. I think I'm going to try the pump. It's safe and apparently works for most men. I'm 56 now. I understand fully you questioning your choice of treatment but we have made that decision and have to live (hopefully live) with it. Good luck with whatever you try. Johnny



Posts: 1013
Joined: Mar 2010

The best method of treatment for prostate cancer to avoid ED (ie., nerve sparing) is NOT surgery and current radiation methods do NOT "nuke the nerves along with the prostate."

Surgery (robotic or open) is an archaic procedure which involves an inherently high risk of ED and incontinence following the procedure and is no longer necessary for men w/low grade PCa (Gleason 6 or 7) w/PSA less than 10.  The BEST procedure currently available is CyberKnife (CK) which delivers radiation w/sub-mm accuracy and which can adjust for body and organ movemet during treatment.  No other treatment can provide this level of precision, NOT surgery nor proton beam therapy (PBT) nor IMRT nor IGRT nor 3DCT.  None of them is any better and most are worse than CK at effectively treatiing low-grade PCA without ANY side effects.

I and several other men on this forum were early adopters of CK and have been successfully treated with it WITHOUT any side effects.  So, if you are looking for the best possible method of treatment to avoid ED, I highly recommend CK (provided, of course, you are eligible for treatment).


Posts: 2
Joined: Aug 2013

VaascodaGamma is right. The only reasearch that shows whether the prostatectomy surgery is open or laparoscopic or laparoscoptic robotic assisted (e.g. DaVinci) the only factor that matters is the number of operations your surgeon has done of that type. I asked mine and he said he did 650+. He did a greart job since I recovdered quickly and had no permanent urinarey incontinance problems. Unfortunately between when the biopsy showed the cancer was contained within the prostate and at the time of the operation he discovered it had metastasized (spread) to my lymph nodes. 

hopeful and opt...
Posts: 2331
Joined: Apr 2009

My non medical opinion is that swingshift worker is right about the active treatment choice, that is SBRT, one of the platforms cyberknife.

I also believe that Active Surveillance, that is watching should be the first choice for a low risk patient.

Proper diagnostic tests are critical when one is diagnosed so the appropropriate treatment is done. ...great idea to have a second opinion by a world class pathologist so one is not under or over treated.......it is very important to have an a high powered MRI test to see if any extracapsular extenstion exists, and determine the extent of suspicious lesions in the prostate. I notice that many doctors with in all active treatment specialties do not perform this test; and unfortunately many of  those who have extracapusular extention are treated by an EXTRA localized treatment...and then  still need to have additionally treatment for cancers that have escaped the capsule.   ...the side effects of various trreatments are cummulative.

Posts: 10
Joined: Aug 2010

Best treatment for nerve sparing? Avoid surgery.

I see the wife wanted to get the cancer out. Surgery

does a poor job of that.


Go to Proton Beam therapy. It is directed energy unlike xrays.


God bless.




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