There's no way to sugar coat this: it is very rare for men to regain normal erectile function (ED) following that most common prostate cancer operation, the radical prostatectomy.

In this procedure, the prostate gland is removed during a prostate cancer operation. This works pretty well towards removing the cancer,  but the nerves which surround the gland are often damaged during the procedure. These are the nerves that give men the ability to have an erection. This situation has improved over time in some cases, but research presented at the European Association of Urology Congress in Madrid makes it clear that achieving an erection of the same quality as before the operation, though possible, is not likely. 

The study was conducted by Dr. Mikkel Fode, from the Herlev Hospital in Copenhagen. He and his colleagues asked 210 patients to complete the International Index of Erectile Function (IIEF) questionnaire, around 23 months after their radical prostatectomy surgery. Fode's study added one new question which distinguished it from previous such exercises: "Is your erectile function as good as before the surgery (yes/no)." Just 14 patients (6.7 percent of respondents) indicated that their erections were as good as before their operation. Contrast that with 49 patients (23.3 percent) who showed no decline in their IIEF score.

As Mikkel Fode said, "The occurrence of sexual dysfunction after prostate cancer surgery is well known but our method of evaluating it is new. What this work shows is that having an erection as good as before surgery is a rare event, with the vast majority of men, more than 93 percent in our sample, experiencing some sexual problems after prostate cancer surgery. Fundamentally, we may have been asking patients the wrong question, but of course we really need bigger trials to confirm this. We think that this work gives a more realistic, idea of the real problems which most men have after prostate surgery.

This is important to know before deciding on undergoing the treatment as your choice might be affected. For men who have already undergone surgery it is important to know that they are not alone in the situation and that their physician will likely be able to help if they discuss the problem."

In comments made at the conference, Professor Francesco Montorsi, Chair Department of Urology, Vita Salute San Raffaele University, Milan, Italy and Editor Emeritus European Urology said: "As the average age of patients undergoing radical prostatectomy is decreasing, maintaining the ability to have an erection after an operation is increasingly important to men facing surgery. This is the first study of its kind, so we need to confirm the findings but above all to learn from problems which can face patients after prostate cancer operations. We need to look more closely at nerve sparing techniques, and ensure that good post-operative care is available for each patient."