My Oct. 2019 PSA was 59.07. Follow-on PSA was 79,3 with PSA Free of 3.45 and PSA Free % = 4.4%. November 2019 needle biopsy showed Gleason 7 for all six prostate areas (Four were 4+3 = 7 and two were 3+4 = 7), "Perineural Invasion: Present: in all six prostate areas. Follow-on full body bone scan showed no bony cancer spread. CT Scan showed "no evidence of metastatic prostate cancer" and "unremarkable appearance of prostate. No convincingly suspicious pelvic lymphadenopathy to suggest nodal disease."
After much consideration and homework, I chose da Vinci surgery about 3 hours from home. Surgery scheduled for March 2020. My first visit with my surgeon is in a few days, and I seek to better understand likelihood of cancer spread, incontinence after surgery, how a surgeon decides to do nerve-sparing surgery or not.
I understand I can first do surgery and radiation later if needed, but I can't start with radiation and then do surgery later.
What might my very high PSA mean? If I risk having nerve-sparing surgery to allow for preserving continence after surgery but there is evidence of cancer in external neurovascular bundles, how effective might follow-on radiation treatment of neurovascular bundles be? I'd really appreciate some patient perspectives. Thanks in advance.