I had PNI found at biopsy on one side. This meant that if I went for RP, it would have been non-nerve sparing (at least on that side, but probably both sides), and probably not good margins, necessitating radiotherapy too, and I would end up suffering side effects from both procedures.
For that and other reasons, I went for radiotherapy only (plus HT of course). In my case, the RT was split 75% external beam RT, and 25% HDR brachytherapy (a combination called HDR boost, although the percentage ratios vary a little between treatment centres).
I'm 4 months post radical treatment, and so far, erections still work fine. There is a risk the RT could still damage the nerves up to 5 or more years after treatment, but this is slightly lower than the risk that natural erections never recover after a nerve-sparing RP. I have to qualify the "works fine" by saying the loss of libido resulting from the accompanying HT kills any desire for erections, but you must force yourself anyway, and I can still get them, same size and hardness, as before, and the loss of libido should reverse when i come off HT.
However, many people with loss of libido on HT can't get erections, or can't get them often enough or for long enough, but you must do so to maintain penile health during your period on HT. You may need an understanding partner, and/or use porn, or used a pump (VED - vacuum erection device to give its proper name). PDE5 inhibitors can also help overcome lack of libido/arousal, 5mg daily low dose Tadalafil is particularly good for this if you can get it prescribed (not all NHS heath authority areas will prescribe it). These measures should only be temporary until you come off HT, unless you are unlucky and suffer late onset radiation damage to nerves as I mentioned above.
EDIT:
Let me just clarify - PNI doesn't necessarily mean no nerve sparing, it just did in my case. PNI is associated with very slightly less successful RP outcomes, but not due to nerve sparing.
Edited by member 09 Dec 2019 at 09:42
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