In the past having a radical prostatectomy almost always resulted in impotence because of damage to the nerves which are needed in order to get an erection.

These nerves, which are called the cavernous nerves, run very close along either side of the prostate gland.

In the 1980s a new way of doing the surgery was worked out in which the cavernous nerves were identified at an early stage during the operation. They were then carefully separated from the tissues around the prostate and in this way could often be preserved, undamaged, whilst the prostate itself was removed.

Surgeons do not know for certain if they can do a nerve sparing radical prostatectomy until they actually do the operation. This is because it is impossible to know for certain whether the cancer has spread into the tissues around the prostate gland until they carry out the surgery. If those tissues are involved then it is usually impossible to spare the nerves without the risk of leaving cancer cells behind. Nerve sparing surgery still does not guarantee that impotence will not be a problem after the operation but it does reduce the risk of problems with getting an erection (often known as erectile dysfunction) from almost 100% with a normal radical prostatectomy to between 20-30% with a nerve sparing operation.