I have aggressive prostate cancer. I am 58 years old. My Gleason 3+4. I have decided on robotic surgery. I am having the surgery exactly six weeks after the biopsy. What is your prognosis on full recovery based upon the above information?
The most important factor is the surgeon doing the operation. Robotic surgery is difficult and the surgeon must have talent and needs to do hundreds of procedures before his skill is mature. There are far more robotic surgical centers than there are skilled surgeons. I have seen some real disasters from surgery performed by unskilled physicians. This is one area where you really do need to look for the very best.
The second factor will be whether the cancer has spread beyond the gland by invading the capsule or seminal vesicle. This may lead the surgeon to sacrifice the neurovascular bundle to the penis on one or both sides. If that happens, the odds of you regaining sexual function are low.
If the cancer has escaped the capsule at the apex of the prostate, the second urinary sphincter may be damaged or destroyed by surgery. This would make it very likely you will be incontinent.
Finally, it is common to find more extensive cancer or higher Gleason at the time of surgery. If you have the capsule breached, the seminal vesicle invaded or a Gleason 8-10 in the surgical specimen, you will be at high-risk for recurrence. If that is the case, you will most likely benefit from adjuvant radiation therapy. Adding radiation to surgery will significantly increase the risk that you will lose sexual function or become incontinent.