Ask the Experts - Nerve-Sparing Surgery for Radical Prostatectomy?
I understand there is a nerve (impotence)-sparing surgical technique for radical prostatectomy for localized Gleason 6 carcinoma available at Johns Hopkins. Is this technique available elsewhere, and what are the chances of avoiding postoperative impotency?

The nerve-sparing prostatectomy is performed with variable skill at many cancer centers. Although the operation has been widely applied, the elements that contribute to its success are as follows:

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  adequate initial pathologic assessment and clinical staging, which lead to the proper selection of patients;
  
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  a "fit" and motivated patient who does not have other medical factors contributing to impotence.
  

In a motivated patient who is correctly selected, a nerve-sparing prostatectomy can result in a cure and avoid impotence in a number of cases.

However, nerve-sparing prostatectomy may not be the correct operation in all circumstances because of the following:

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  the location of the cancer does not permit a nerve-sparing approach without an excessive risk of incompletely removing the cancer;
  
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  the cancer is too high-grade or extensive to consider a curative operation.