Introduction: Although radical prostatectomy is the golden standard treatment modality for organ confined prostate cancer, postoperative erectile dysfunction is one of the important quality of life problems in urological practice. Here in, we analyzed current strategies for preventing and managing postoperative erectile dysfunction with respect to safety and efficacy. Materials and Methods: We systematically reviewed the current articles by using Medline and addressed the important points for prevention and management of postoperative erectile dysfunction. Results: Proper patient selection and meticulous surgical technique are the important determinants of outcome of the surgery with respect to erectile dysfunction. Early pharmacological treatment for penile rehabilitation should be offered as an effective and safe treatment. Nerve grafting, growth factors, immunophilines, gene and stem cell treatment are promising modalities for the future. Conclusion: Properly selected patients, an experienced surgeon and early penile rehabilitation may diminish erectile dysfunction and increase quality of life of patients without compromising cancer surgery goals.