OK, I'll take a crack at it. I believe that the controlling criteria are
the tumor burden and the likelihood of extra-capsular penetration. As I
recall, both are rather high in Steve's case.

I do not believe that PSA is controlling, except to the extent that it
provides some evidence of tumor burden.

But whether nerve sparing is possible often cannot be determined until
the surgery is under way. See, Strum & Pogliano _A Primer on Prostate
Cancer_ pages 75-77.

And, yes, the MRI (2/20?) should develop helpful info.

Sorry about the bleak outlook, but don't give up yet. And, if worse
comes to worse, think sural nerve transplant.

Regards,

Steve J

We saw a surgeon today, Kletscher, seemed very caring, competent,
experienced. He said he does do nerve sparing surgery, but he was going
to be honest and that he didn't think it likely in Steve's case.
Apparently because the high PSA and fact that biopsy shows cancer on
both sides. Although the MRI may give more info.
Does this sound right? Are all those nerve sparing surgeries on the guys
with PSAs under 10 or 20? Any input will be appreciated.
==========
here's something that i've picked up along the way.  all the tests and
reports are best indicators but the true situation is not known until
they open everything up and take a look.

i've seen operations go both ways and for different, but solid reasons.

i had a psa of 6.35 and had my nerves spared, while another man, who had
a psa of 6.25 was operated on by the same surgeon at the same hospital
and the couldn't save his nerves.

i have a friend who had a psa of 10 the year before and the doctor never
told him that something was wrong, then when he got his psa ran the
following year, it was 16 and then they decided to the biopsy, and they
were able to save one side of nerves.

the bottom line is this.  this is what my surgeon told me.   he said
that when he gets in there and gets to the erectile nerves.  if the
prostate tissue slides off the nerve like the meat does on a piece of
chicken, then the prostate cancer has not attacked the nerve.   but the
cancer is sticky and will stick to the nerve as it attacks it.  if it
isn't too bad,  there will be "flakes" of cancer and he can strip that
off of the nerve, but if the prostate tissue to stuck solid to the nerve
bundle, then there is nothing left to do but cut the nerve bundle and
remove it with the prostate.

on the flip side, it is possible to do nerve grafting and you need to
discuss that as an option with your surgeon.

hope this information helps.

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc

I think the others have more or less confirmed what your doctor told
you, and they also gave you some other useful information.  But one
thing to keep in mind is that even if the nerves aren't spared,  you can
still have a relatively normal sex life.   I was impotent for 18 months
following surgery.  During that time,  I used a pump (VED) with
reasonable success and my wife and I maintained an active sex
life---about the same as before surgery.  Other men have used injections
successfully.  Finally, if all else fails, there is the possibility of
penile implants.  It is a rather drastic solution,  but apparently men
who do have it done are generally satisfied with the results.

I think your doc is being very honest with you.  You may have picked a
very good surgeon.

Good luck

Dale j.

My PSA was 16.  My doc didn't think nerve-sparing was a good idea in my
case.  The post-op biopsy proved him correct.