After incontinence, impotence ranks right up there on the “most feared complications” list. But let’s make sure we’re all talking about the same thing: First of all, what is potency? The medical definition is simple—”an erection sufficient for vaginal penetration and orgasm.” Having said that, it’s worth repeating that men who are impotent after radical prostatectomy have normal sensation, normal sex drive and can achieve a normal orgasm. Their only problem may be in achieving or maintaining an erection. (For a more specific discussion of impotence after radical prostatectomy, and for suggestions on dealing with this problem, see Chapter 8.)

In a Johns Hopkins analysis of 503 potent men, 34 to 72 years old, 68 percent remained potent after radical prostatectomy. Age and the stage of cancer as well as surgical technique—the surgeon’s skill, and whether or not one or both neurovascular bundles were removed during the operation—all can affect potency. The breakdown, by age: Potency was preserved in 91 percent of men younger than 50, in 75 percent of men aged 50 to 60, in 58 percent of men aged 60 to 70, and 25 percent of men over 70.

In men younger than 50, the potency rate is similar (about 90 percent) in men who kept both neurovascular bundles intact, and in men who had one nerve bundle removed. This suggests that all that’s needed for men to achieve erection is one of these nerve bundles, and that nature has provided a spare.

In men older than 50, however, the sexual potency rate was higher in men who had both neurovascular bundles preserved than in men who lost one bundle. When the relative likelihood of impotence after surgery is adjusted for age, the risk is twice as high if the cancer has penetrated the prostate wall; if it has invaded the seminal vesicles; or if one neurovascular bundle has been removed.

To sum up: The men most likely to remain potent are younger, with disease confined to the prostate. These also are the men who will benefit most from surgery.

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