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Is a Nerve-Sparing Prostatectomy the Best Surgery for My Prostate Cancer?


No one ever wants to hear that they have cancer. The word brings many fears and questions to mind. Yet, when a man is diagnosed with prostate cancer, there are many treatment options available to him, treatments that expand beyond prostatectomy, a surgery performed on the prostate.

Is prostate cancer common?

Each year more than 280,000 men will be diagnosed with prostate cancer according to the American Cancer Society. A conservative estimate is that one in eight men will receive a prostate cancer diagnosis in his lifetime. To catch prostate cancer in early stages men who are approaching age 50 are encouraged to discuss their prostate cancer risks including family history with their doctor. Many men begin to get screened starting at age 50 or older, and men who are at increased risk, like African American men or men who have family history of prostate cancer may seek out screening at even younger ages, sometimes starting around age 40 or 45. The majority of prostate cancer patients are age 65 or older when they are first diagnosed.

What are the symptoms of prostate cancer?

In its early stages, there are no symptoms of prostate cancer.  As the disease progresses, men can experience a wide range of symptoms, including urinary symptoms or hip/back pain.  Men may rationalize these as a natural part of aging and fail to mention them to health care providers. Symptoms associated with both prostate cancer and a natural enlarging of the prostate gland include:

  • Difficulty empty their bladder, including a hard time starting to urinate and maintaining a steady stream of urine
  • Increased frequency urinating, especially at night

Symptoms that suggest a more concerning process may include:

  • Pain and burning when urinating
  • Pain when ejaculating
  • Seeing blood in urine
  • Seeing blood in semen and
  • Pain in the lower back, hips, and lower abdomen that is constant

While these symptoms may feel uncomfortable to mention to your doctor, they are important to report. They may indicate prostate cancer, may indicate an enlargement of the prostate, or may be an issue with another organ. Likely your provider will refer you to getting screened or will conduct a screening themselves.

How can I get screened for prostate cancer?

The first step in a screening for prostate cancer is very straightforward. It is a simple blood test called a prostate-specific antigen test, or PSA test for short. Because it is a blood test, it will involve a needle prick but doesn’t require fasting for an accurate reading. Your blood can have low, normal, or elevated PSA levels. An elevated PSA level in the blood means there are higher levels of a protein the prostate makes in the body. This elevated PSA can happen for a few different reasons, so a few other tests may be required to see if this higher PSA level could be because of prostate cancer. If the PSA is higher, your doctor may want to order an ultrasound or do an exam that they can conduct during an office visit. The purpose of the digital (gloved hand) rectal exam is to assess the size of the prostate and feel for any abnormal nodules or bumps that may indicate prostate cancer. Read more about prostate cancer screenings on

How could prostate cancer impact me every day?

Aside from the initial concern of hearing a cancer diagnosis, many men don’t just worry about surviving, they also have quality of life questions for during and after treatment. It’s very common to wonder, “how will I pee after a prostatectomy?” or “can I still get an erection if the prostate is removed?” These are very understandable questions about how the diagnosis and treatment will impact day-to-day activities. Advances in prostate cancer detection, treatment, and post-treatment survivorship have greatly improved patient outcomes over the past few decades. Many men are treated for prostate cancer and subsequently live cancer-free with a full quality of life.  When diagnosed with prostate cancer, it is important for men to speak with a urologist to discuss treatment options and the personalized impact these treatments may have.

What are some prostate cancer treatment options?

Today there are many prostate cancer treatment options to consider after a diagnosis. Surgery is not a given, in fact some approaches involve purposefully waiting to see how the cancer develops. Different treatments can also be combined for a unique-to-you plan. The standard options for prostate cancer treatment at Siteman include:

  • Active surveillance and watchful waiting
  • Focal therapy
  • Surgery (includes nerve-sparing prostatectomy and other surgical approaches)
  • Radiation therapy
  • Systemic therapy

Will a nerve-sparing prostatectomy protect my sex life?

Unlike the past, where a prostate cancer diagnosis and surgery removing the prostate meant impotence, today, physicians specialize in nerve-sparing prostatectomy approaches. There are multiple approaches that surgeons can take that try to protect the nerve bundles located on both sides of the prostate. While those approaches vary from surgeon to surgeon, they are each considered to be a nerve-sparing prostatectomy. Any surgery on the prostate does open up the possibility for nerves to be damaged during the surgery itself or while healing. But when planning the surgical approach, the cancer’s location, and other factors, and the patient’s desire for maintained sexual health and function are all considerations.

Self-advocacy in cancer care is important and welcome. Often patients request a nerve-sparing prostatectomy from their physician following a prostate cancer diagnosis. This is an excellent preference to voice to your physician, but a nerve-sparing prostatectomy may not even be necessary when looking at the medical history and factors about the cancer itself. Experts at Siteman Cancer Center will be able to make a well-informed recommendation on what kind of care is needed. A nerve-sparing prostatectomy is a kind of surgery and because of medical advances, sometimes, surgery for prostate cancer is not needed at all. For instance, radiation or a systemic therapy could be options that lead to a cancer-free future without undergoing surgery.

Can a nerve-sparing prostatectomy impact my fertility?

Nerve-sparing prostatectomy or any other kind of surgery on the prostate can potentially impact male fertility since the gland plays an important role in the production of semen. Because prostate cancer is more prevalent in men who are older than 60, it may not impact your life goals. But for some men, family planning and fertility are important considerations when creating a treatment plan. There are several options and resources to consider. If your care is taking place at Siteman Cancer Center, you can request a referral to the Infertility and Reproductive Medicine Center at WashU. Even if you aren’t getting care at Siteman, you can become a new patient at the Center to explore your options.

How is prostate cancer care advancing?

At Siteman Cancer Center experts are driving the standard of care forward through multidisciplinary care. Depending on the case, patients may receive a combination of different interventions like radiation, chemotherapy, and surgery. Or newer interventions like focal therapy and proton beam therapy or systemic therapies like hormone therapy and immunotherapy may be what your oncologist feels are best. Taking a team approach with combined expertise and specialties open up many possible plans based on every patient’s specific cancer and life circumstance. Clinical trials for prostate cancer are also ongoing at Siteman. These trials are shaping the next phase of research-based cancer care.

You can ask your doctor about these advances, or request an appointment at Siteman for a consultation. Getting a second opinion about your care is always an option available to you at any stage of your journey.