Yes, you may still be able to have robotic prostate surgery if your cancer is close to the nerves that help with erections. Your surgeon will look at where the cancer is and decide how much nerve tissue can be safely preserved.
If the cancer is very close to the nerves, your surgeon may need to remove more tissue on that side to reduce the risk of a positive surgical margin. Your MRI, biopsy and other test results help guide this decision.
Why Do the Nerves Beside Your Prostate Matter?
The nerves that help control erections run in neurovascular bundles very close to each side of your prostate.
During surgery, your surgeon tries to protect these nerves where it is safe to do so. If your cancer is close to them, removing the cancer safely may mean preserving fewer nerves.
What Does Nerve-Sparing Robotic Prostate Surgery Mean?
Nerve-sparing surgery means your surgeon tries to protect the nerves beside your prostate during the operation.
If it is safe, this may improve your chances of recovering erections. If your cancer is close to the nerves, your surgeon may need to remove more tissue on that side to remove the cancer safely.
Does Cancer Close to a Nerve Mean the Nerve Contains Cancer?
No, cancer being close to a nerve does not automatically mean the nerve contains cancer. Your surgeon will assess several findings to understand how safely the nerve can be preserved.
- MRI Findings: Your MRI helps show how close the cancer appears to be to the nerves beside your prostate.
- Biopsy Results: Your biopsy gives information about where the cancer is located and how aggressive it may be.
- Cancer Grade: Your Grade Group helps your surgeon estimate the risk of cancer extending beyond the prostate.
- Surgical Planning: Your surgeon may remove more tissue on the affected side if there is concern about cancer extending towards the nerves.
Your surgeon will consider all of these findings together rather than relying on one test alone. The aim is to remove your cancer safely while preserving as much healthy nerve tissue as possible.
Can MRI Tell for Certain Whether Cancer Has Reached the Nerves?
No. Your MRI can give your surgeon a good idea of where your cancer is, but it cannot always show tiny areas of cancer spread.
Your surgeon will look at your MRI along with your biopsy, PSA and other results. This helps them decide how much nerve tissue can be safely preserved.
How Does MRI Help With Nerve-Sparing Decisions?
Your MRI helps your surgeon see where your cancer is and how close it is to the nerves beside your prostate.
If your MRI suggests a low risk of cancer extending towards the neurovascular bundle on one side, your surgeon may be able to preserve more nerve tissue on that side. If it looks very close, they may need to remove more tissue to treat your cancer safely.
How Does Your Biopsy Affect the Nerve-Sparing Plan?
Your biopsy tells your surgeon how aggressive your cancer looks and where it is in your prostate. This helps them understand how close the cancer may be to the nerves.
You may have more nerves preserved on one side than the other, depending on where your cancer is. Your surgeon will use your biopsy and MRI results to plan what is safest for you.
Why Does Your Grade Group Matter?
Your Grade Group helps your surgeon understand how aggressive your cancer may be. A higher Grade Group can be associated with a greater risk that cancer has extended beyond the prostate.
But having a higher Grade Group does not automatically mean your nerves cannot be preserved. Your surgeon will look at where the cancer is and decide what is safest for you.
Evidence Note
Current European prostate cancer guidance recommends offering nerve-sparing surgery when there is a low risk of cancer extending outside the prostate on that particular side. This means nerve sparing is a side-specific decision rather than simply a yes-or-no decision for the whole prostate.
MRI is useful but cannot make this decision on its own. A systematic review of 17 studies involving 3,374 patients found that multiparametric MRI detected only around 55% of extraprostatic extension (EPE), although its specificity was around 87%. A negative MRI therefore cannot completely exclude microscopic extension, which is why your surgeon also considers your biopsy, Grade Group, PSA, clinical stage and other findings.
Can Your Surgeon Save the Nerves on Only One Side?
Yes. You may have more nerves preserved on one side than the other, depending on where your cancer is.
If your cancer is close to the nerves on one side, your surgeon may preserve more nerve tissue on the other side. This allows them to balance nerve preservation with treating your cancer safely.
Which Nerve-Sparing Approach Might Be Used?
| Surgical Approach | What It Generally Means |
| Bilateral nerve sparing | Neurovascular tissue is preserved on both sides where the cancer risk and anatomy allow it |
| Unilateral nerve sparing | More nerve tissue is preserved on one side, while a wider excision is used on the side with greater concern about cancer extension |
| Partial or incremental nerve sparing | Some neurovascular tissue may be preserved rather than using either complete preservation or complete sacrifice on that side |
| Non-nerve-sparing surgery | A wider dissection is used when preserving the neurovascular bundles could compromise safe cancer removal |
The appropriate approach depends on the estimated risk on each side of your prostate. Your MRI, biopsy, Grade Group, PSA, clinical stage, existing erectile function and your surgeon’s assessment can all contribute to the plan.
Does Nerve Sparing Increase the Risk of a Positive Surgical Margin?
Nerve sparing has been associated with a higher risk of a positive surgical margin on the side where it is performed, which is why careful patient selection is important. If there is significant concern that cancer extends beyond your prostate on one side, your surgeon may use a wider dissection on that side instead.
The decision is therefore made separately for each side. Your MRI, biopsy, Grade Group, PSA and clinical findings help your surgeon decide whether nerve preservation is appropriate while keeping safe cancer removal the priority.
What If the Cancer Is Touching the Edge of the Prostate Near the Nerves?
If your cancer is very close to the edge of your prostate near the nerves, your surgeon may need to remove more tissue on that side.
Your surgeon will put treating your cancer safely first, while preserving as much nerve tissue as they can.
What Is a Positive Surgical Margin and Why Does It Matter?
A positive surgical margin means your pathologist finds cancer cells at the inked surgical surface of the tissue removed during your operation.
A positive margin is associated with a higher risk that your PSA may rise again after surgery, but it does not prove that cancer remains in your body. To reduce the chance of a positive margin, your surgeon may need to remove more tissue near the cancer while preserving nerve tissue where this can be done safely.
Can the Nerve-Sparing Plan Change During the Operation?
Yes. Your surgeon may change the nerve-sparing plan during the operation if what they find suggests that more tissue needs to be removed on one side.
Your MRI and biopsy cannot show everything. Your surgeon will always put removing the cancer safely first, while preserving as much nerve tissue as possible for you.
What Is NeuroSAFE and Can It Help Preserve the Nerves?
NeuroSAFE is a technique that allows tissue next to the neurovascular bundle to be checked quickly for cancer cells while your operation is still taking place.
If the margin is clear, more nerve tissue may be preserved. If cancer is found at the margin, additional tissue can be removed on that side where appropriate. NeuroSAFE is not available at every hospital.
Research Insight
The 2025 UK NeuroSAFE PROOF randomised trial compared NeuroSAFE-guided robotic prostatectomy with standard robotic surgery. Among patients with good erectile function before treatment, those receiving NeuroSAFE-guided surgery had better patient-reported erectile-function scores at 12 months. Urinary continence scores were also better at three months, although there was no significant difference at six months.
These findings suggest that NeuroSAFE can improve functional outcomes in appropriately selected patients by supporting nerve-preservation decisions. However, the trial does not mean that NeuroSAFE is necessary or suitable for every prostatectomy, and it cannot guarantee erectile-function recovery.
Does Nerve Sparing Guarantee That Your Erections Will Return?
No. Even if your surgeon preserves both nerve bundles, you cannot be guaranteed that your erections will return to how they were before surgery.
Nerve sparing gives you a better chance of recovery, but your age, erections before surgery and how much nerve tissue can be preserved all affect your recovery.
What Happens If Neither Nerve Bundle Can Be Safely Preserved?
If there is a significant risk of cancer extending towards both neurovascular bundles, your surgeon may need to perform a wider non-nerve-sparing dissection on one or both sides. This can make natural erections after surgery less likely.
This does not mean you cannot have a sex life. Treatments such as vacuum devices, injections and implants may still help you achieve an erection.
What If Only One Nerve Bundle Can Be Preserved?
If your surgeon can preserve one nerve bundle, you may still have a chance of recovering erections after surgery. Your recovery will also depend on your erections before surgery and other factors.
If your erections do not recover sufficiently, treatments may help you achieve erections. Your surgeon or specialist nurse can discuss the most suitable options for you.
UK Guidance Note
NICE recommends discussing how radical prostate cancer treatment may affect your sexual experience and erections before treatment. If you develop erectile difficulties afterwards, you should have access to specialist erectile dysfunction services.
If you develop erectile dysfunction after prostate cancer treatment, NICE recommends PDE5 inhibitor tablets when suitable. If these do not work or are unsuitable, options can include vacuum devices, intraurethral treatment, penile injections or a penile prosthesis. The most appropriate treatment depends on your nerve-sparing status, erections before surgery, general health and individual preferences.
Should Erectile Function Affect Whether You Choose Surgery?
Yes. Your sexual function is an important part of choosing treatment, alongside how well each option is expected to control your cancer. Ask your surgeon how much nerve sparing they expect to achieve and what this may mean for you.
Your doctor can also explain how other treatment options may affect your erections. The most suitable treatment choice depends on your cancer characteristics, general health, sexual priorities and the likely effects of each treatment on your quality of life.
What Should You Ask Your Surgeon Before Robotic Prostate Surgery?
Before your surgery, ask where your cancer is in relation to the nerves and whether the risk is the same on both sides. You can also ask how your MRI and biopsy results affect your nerve-sparing plan.
Ask how much nerve tissue your surgeon expects to preserve and whether the plan could change during surgery. It is also worth asking what support you will have for erectile recovery afterwards.
Myth vs Fact
| Myth | Fact |
| Cancer close to the nerves means you cannot have robotic prostate surgery. | Robotic prostatectomy may still be an option. The main question is how much tissue your surgeon needs to remove on each side to treat the cancer safely. |
| Cancer close to a neurovascular bundle means the nerve definitely contains cancer. | Proximity does not prove nerve involvement. Your surgeon estimates the risk of extraprostatic extension using MRI, biopsy, Grade Group, PSA, stage and other findings. |
| A clear MRI proves that full nerve sparing is safe. | MRI can miss microscopic extraprostatic extension, so nerve-sparing decisions should not be based on MRI alone. |
| Both nerve bundles must either be saved or removed together. | Nerve sparing is often side-specific. Bilateral, unilateral, partial or non-nerve-sparing approaches may be considered depending on the cancer risk on each side. |
| NeuroSAFE guarantees that the nerves can be preserved. | NeuroSAFE provides rapid information about the surgical margin next to the neurovascular bundle, but additional tissue may still need to be removed if cancer is found. |
| If the nerves are preserved, your erections will definitely return. | Nerve preservation improves the possibility of recovery but does not guarantee it. Age, erections before surgery, extent of nerve preservation and other individual factors all influence the outcome. |
Key Takeaways:
- Cancer being close to the neurovascular bundles does not automatically prevent you from having robotic prostate surgery.
- Nerve sparing is usually a side-specific decision based on the estimated risk of cancer extending outside the prostate on each side.
- MRI is useful for surgical planning but cannot exclude every microscopic area of extraprostatic extension, so biopsy, Grade Group, PSA and other findings also matter.
- Your surgeon may use bilateral, unilateral, partial or non-nerve-sparing surgery depending on the cancer risk on each side and how much nerve tissue can be safely preserved.
- NeuroSAFE can help guide nerve-preservation decisions in centres where it is available, but it does not guarantee nerve preservation or erectile recovery.
- Even after nerve-sparing surgery, erectile recovery can take many months and is not guaranteed; specialist treatments are available if erections do not recover sufficiently.
Frequently Asked Questions
1. Can You Have Robotic Prostate Surgery If Your Cancer Is Close to the Nerves?
Yes, you may still have robotic prostate surgery if your cancer is close to the nerves. Your surgeon will assess your MRI, biopsy and cancer location to decide how much nerve tissue can be safely preserved.
2. What Are the Nerves Beside Your Prostate?
The nerves beside your prostate form part of the neurovascular bundles that help you achieve erections. Your surgeon will try to preserve them where this can be done safely without compromising cancer removal.
3. Does Cancer Close to a Nerve Mean the Nerve Contains Cancer?
No, cancer being close to a nerve does not necessarily mean it has reached the nerve. Your surgeon will use your MRI, biopsy and other findings to assess the risk and plan your surgery.
4. How Does Your MRI Help With Nerve Sparing?
Your MRI helps your surgeon see where your cancer is and how close it appears to the nerves. If the cancer is very close, your surgeon may need to remove more tissue on that side.
5. Can Your Surgeon Preserve Nerves on Only One Side?
Yes, your surgeon may preserve more nerve tissue on one side than the other. This may help preserve erectile function while allowing a wider excision on the side with greater concern about cancer extension.
6. Can Your Nerve-Sparing Plan Change During Surgery?
Yes, your surgeon may change the nerve-sparing plan if what they find during surgery suggests that more tissue needs to be removed. Your surgeon will aim to remove the cancer safely while preserving as much nerve tissue as possible.
7. What Is NeuroSAFE During Robotic Prostate Surgery?
NeuroSAFE allows tissue next to your nerves to be checked during surgery for cancer cells. If the tissue is clear, your surgeon may be able to preserve more nerves, while cancer at the margin may require further tissue removal.
8. Does Nerve Sparing Guarantee Your Erections Will Return?
No, nerve sparing cannot guarantee that your erections will return after surgery. Your age, erections before surgery and how much nerve tissue can be preserved can all affect your recovery.
9. What Happens If Only One Nerve Bundle Can Be Preserved?
If your surgeon preserves one nerve bundle, you may still have a chance of recovering erections. Your specialist can also discuss treatments that may support your erectile recovery if needed.
10. What Should You Ask Your Surgeon About Nerve Sparing?
Ask how close your cancer is to the nerves, whether nerve sparing is possible on both sides and how much nerve tissue your surgeon expects to preserve. You can also ask how this may affect your erectile recovery after surgery.
Final Thoughts: Understanding Nerve Sparing During Robotic Prostate Surgery
If your prostate cancer is close to the nerves, you may still be able to have robotic prostate surgery. Your surgeon will carefully assess your MRI, biopsy and cancer location to decide how much nerve tissue can be preserved while still removing the cancer safely.
If you are considering robotic prostate surgery in London and would like specialist advice, you can contact Prostate Clinic London to discuss your treatment options and arrange a consultation tailored to your individual needs.
References:
- National Institute for Health and Care Excellence (NICE) (2019, updated 2021) Prostate cancer: diagnosis and management. Available at: https://www.nice.org.uk/guidance/ng131
- University College London Hospitals NHS Foundation Trust (2026) Robotic prostatectomy. Last updated 4 March 2026. Available at: https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/robotic-prostatectomy
- Zhang, F., Liu, C.-L., Chen, Q., Shao, S.-C. and Chen, S.-Q. (2019) ‘Accuracy of multiparametric magnetic resonance imaging for detecting extracapsular extension in prostate cancer: a systematic review and meta-analysis’, The British Journal of Radiology, 92(1104), article 20190480. Available at: https://pubmed.ncbi.nlm.nih.gov/31596123
- Liu, Y., Deng, X.-Z., Qin, J., Wen, Z., Jiang, Y., Huang, J., Wang, C.-J., Chen, C.-X., Wang, L., Li, K.-P., Wang, J.-H. and Yang, X.-S. (2023) ‘Erectile function, urinary continence and oncologic outcomes of neurovascular bundle sparing robot-assisted radical prostatectomy for high-risk prostate cancer: a systematic review and meta-analysis’, Frontiers in Oncology, 13, article 1161544. Available at: https://pubmed.ncbi.nlm.nih.gov/37091146
- Dinneen, E., Almeida-Magana, R., Al-Hammouri, T. et al. (2025) ‘Effect of NeuroSAFE-guided RARP versus standard RARP on erectile function and urinary continence in patients with localised prostate cancer (NeuroSAFE PROOF): a multicentre, patient-blinded, randomised, controlled phase 3 trial’, The Lancet Oncology, 26(4), pp. 447–458. Available at: https://pubmed.ncbi.nlm.nih.gov/40147459
- European Association of Urology (2026) EAU Guidelines on Prostate Cancer. Available at: https://uroweb.org/guidelines/prostate-cancer
- Nicolai, M., Urkmez, A., Sarikaya, S., Fode, M., Falcone, M., Albersen, M., Gul, M., Hatzichristodoulou, G., Capogrosso, P. and Russo, G.I. (2021) ‘Penile rehabilitation and treatment options for erectile dysfunction following radical prostatectomy and radiotherapy: a systematic review’, Frontiers in Surgery, 8, article 636974. Available at: https://pubmed.ncbi.nlm.nih.gov/33738297