Indications and contraindications for nerve-sparing radical prostatectomy

With the success of prostate-specific antigenscreening programs, many prostate cancers are being diagnosed at an earlier stage when men are more concerned about maintaining sexual function. Cavernous nerve preservation surgery employed to preserve erectile function can be performed safely in the majority of men undergoing radical prostatectomy. Nonetheless, as the primary goal of any extirpative cancer operation is to remove all of the tumor, factors that are associated with an increased risk of leaving a positive surgical margin must be taken into consideration when evaluating a patient for nerve preservation surgery. This article discusses contraindications to nerve-sparing radical prostatectomy and describes the use of standardized frozen section analysis to help guide intraoperative decision-making regarding neurovascular bundle preservation.