While changes to erections are common after prostate cancer surgery, there are many treatments and strategies available to help men recover sexual function over time.
One of the most common questions men ask before prostate cancer surgery is: “Will this affect my erections?”
If you or someone close to you is preparing for a radical prostatectomy (surgery to remove the prostate), understanding why this can happen may help you feel more prepared.
How Erections Normally Work
An erection depends on two important systems working properly:
Healthy blood flow to the penis
Healthy nerve signals from the brain
Both of these travel through structures called neurovascular bundles. These bundles contain nerves and blood vessels that run along the back surface of the prostate before heading to the penis.
There are two bundles:
One on the right side
One on the left side
When these nerves send signals normally and blood flow is healthy, erections occur naturally.
Why Erectile Function Can Decline Over Time
Even before surgery, many men notice erections are not as strong as they once were. This can happen because the nerves and blood vessels become affected by:
Ageing
Diabetes
High blood pressure
High cholesterol
Smoking
Being overweight
Previous pelvic radiotherapy
These factors can gradually reduce nerve function and blood flow.
What Happens During Prostate Cancer Surgery?
When surgeons perform a radical prostatectomy, they must carefully remove the prostate while also trying to preserve the surrounding structures.
Because the erection nerves sit directly against the prostate, they can be affected during surgery.
Surgeons aim to perform “nerve-sparing surgery” whenever it is safe to do so. This means carefully separating the nerves from the prostate and preserving them.
A helpful way to think about this is like peeling an onion.
The prostate has layers around it. During surgery, the surgeon gently peels away the outer layer of tissue to separate the nerves from the prostate while removing the gland.
However, this is not always possible.
When Nerves Cannot Be Safely Spared
The most important priority in prostate cancer surgery is removing the cancer completely.
If cancer is located close to the nerves, or if there is concern that it may be spreading beyond the prostate, surgeons may need to remove tissue near the nerves to ensure the cancer is fully treated.
Factors that influence this decision include:
How aggressive the cancer is (Gleason score)
The size of the cancer on MRI
Results of PET scans
Where the cancer sits inside the prostate
Whether the tumour can be felt during examination
If the cancer is very close to the neurovascular bundle, preserving the nerve may increase the risk of leaving cancer behind.
In those cases, protecting long-term cancer control becomes the priority.
What Happens to Erections After Surgery?
Even when nerves are preserved, erections usually do not return immediately.
Most men experience something called neuropraxia after surgery.
This simply means the nerves have been temporarily bruised or stunned during the operation.
Nerves act like electrical cables that carry signals. When they are bruised:
Fewer signals travel along the nerve
The signals are weaker
Erections may not occur for a period of time
Recovery can take months to sometimes over a year.
Who Is More Likely to Recover Erectile Function?
Men are more likely to recover erections if:
Both nerves are spared
They had good erections before surgery
They are younger (generally under 65)
They have few health risk factors such as diabetes or vascular disease
If one or both nerves cannot be spared, the chance of natural erections returning is lower.
The Important Takeaway
Erectile function after prostate surgery depends on several factors:
The location and aggressiveness of the cancer
Whether the erection nerves can be safely preserved
Age and general health
Erectile function before surgery
While changes to erections are common after prostate cancer surgery, there are many treatments and strategies available to help men recover sexual function over time.
If You Have Questions
If you are preparing for prostate cancer surgery, it’s completely normal to have questions about recovery and sexual health.
Speaking openly with your urologist about:
Your current erectile function
Your expectations after surgery
Treatment options for recovery
Can help you feel more confident and prepared for the journey ahead.