Many men, especially younger ones, fear prostate cancer surgery for its potential side effects of impotency and incontinence. — AFP
A technique to preserve nerves during prostate cancer surgery almost doubles the proportion of men who keep erectile function, according to a new study.
Compared to standard surgery, researchers said the new method could dramatically improve men’s quality of life.
Experts from University College London (UCL) and University College London Hospitals NHS Foundation Trust (UCLH) in Britain led the study, which was presented last month (March 2025) at the European Association of Urology Congress in Madrid, Spain, and published in the Lancet Oncology journal.
It evaluated a method called NeuroSafe to preserve the nerves running through the prostate’s outer layers, which are thought to be responsible for producing erections.
In this technique, the prostate is removed while the nerves are left intact during cancer surgery.
The prostate is then examined closely by a pathologist while the patient is still in surgery.
The pathologist slices the area near to the nerves in 5mm strips, which are then quickly frozen and stained so they can be looked at through a microscope.
The samples are analysed to see if any cancer cells are present.
If there are none, the surgeons know that they can leave the patient’s nerves intact in their body.
If cancer is present, the nerves will have to be removed.
NeuroSafe happens in real time during the operation, making it vastly different to traditional methods, where tissue samples are sent off and it takes two or three weeks to get results back.
Clinical trial lead and consultant urologist Prof Dr Greg Shaw said that some younger men in particular, worry about surgery causing impotence and incontinence.
“Our results show that, by using NeuroSafe, nearly twice as many men don’t have to face potentially life-changing loss of erectile function after prostate surgery.
“It is an involved procedure that requires expertise, but it isn’t expensive, particularly given the benefits it offers for patients, and most importantly, doesn’t jeopardise cancer control,” he said.
He added: “NeuroSafe wouldn’t be appropriate for all patients, as many can safely have nerve-sparing surgery using standard robotic techniques.
“But for younger patients and those who wouldn’t normally be seen as eligible for nerve-sparing surgery, it offers them a greater chance to hold onto their quality of life.”
Prof Shaw said the technology is not new, but “whereas before there wasn’t evidence to support this approach, now we have the data to show that, actually, your outcomes are better”.
Some 30% of the men in the study were from Afro-Caribbean backgrounds.
They tend to be diagnosed at a younger age with prostate cancer than their white counterparts.
The trial ran at five British hospitals and included 344 men diagnosed with prostate cancer.
Half were randomised to receive NeuroSafe during their operation and half had standard surgery.
Twelve months after surgery, 39% of men in the NeuroSafe group had no or mild erectile dysfunction.
In those men who had standard surgery, this was 23%.
A year after their operation, only 38% of those who had surgery using NeuroSafe had severe erectile dysfunction, compared to 56% of men who had standard surgery.
NeuroSafe patients who recovered their urinary control also did so faster than patients who underwent standard surgery.
Prof Shaw now hopes that more men will be able to access NeuroSafe on the British National Health Service (NHS) as long as the right pathology support is available.
He said: “Whether it can be rolled out or not depends on, I think, finding a good test that gives a similar result (to the pathologist’s work) that’s perhaps more easily performed, because it’s quite complex.
“But the impetus for the community is you’re doubling the chances of a man being potent afterwards. And that’s compelling.”
UCL research fellow and urologist Dr Ricardo Almeida-Magana said: “NeuroSafe offers surgeons a real-time evaluation of the safety of the procedure.
“In standard robotic surgery, surgeons determine whether to choose nerve-sparing based on MRI scans, on digital rectal examinations, and on biopsy results prior to surgery.
“But whereas those methods can provide guidance, NeuroSafe provides certainty.
“And that opens up the option of nerve-sparing surgery for many more men, without compromising on the chances of controlling the cancer.” – PA Media/dpa
