Table of Contents

Chapter 2: Initial Treatment: Weighing the Pros and Cons of Each Option

i. Nerve-Sparing Prostatectomy

A few new advances have come along in recent years that are designed to maximize benefits and to minimize side effects. By far, the most important one is the nerve-sparing technique. As we noted above, the nerves that control erectile function lie right alongside the prostate. If no care is given to sparing them, erectile function is almost always lost. The nerve-sparing technique was first pioneered in the 1980s, and has since been practiced and perfected by thousands of surgeons around the world. But that doesn’t mean it’s always done.

In order to spare the nerves, the surgeon has to carefully cut to the very edges of the prostate. This is an important issue because if there are any cancer cells beyond where the surgeon has cut, they can grow and spread, and you will not be cured. If your cancer has spread outside of the prostate, the surgeon will need to cut out more of the surrounding tissues and therefore likely won’t be able to spare the nerves.Obviously, if this is known in advance, you will be able to take this into consideration when making your treatment choice. But sometimes the CT or MRI won’t show that the cancer has spread, and the doctor will be forced to make the final decision after the operation has already begun.

In short, the decision on whether to attempt a nerve-sparing procedure should be yours—only you can know how important it is to maintain your erectile function. But ultimately the decision on whether to perform the nerve-sparing procedure is up to the surgeon based on his or her years of experience and expert clinical judgment. Remember that the goal of the surgery is to cure you of your disease. If the surgeon does not feel that he or she can cure you and leave the nerves intact, the nerves will not be spared.