• Posted March 28, 2025

New Surgical Technique Preserves Erectile Function In Prostate Cancer Patients

A pioneering technique can help nearly twice as many men preserve erectile function following prostate cancer surgery, researchers say.

The new surgical method, called NeuroSAFE, preserves the nerves that run through the prostate’s outer layers, which are thought to be responsible for producing erections, according to a report published March 24 in The Lancet Oncology.

The technique also includes an additional test to make sure all cancer is removed. This helps ensure that preserving the nerves does not risk the surgery’s success, researchers said.

“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,” researcher Greg Shaw, a consultant urologist at the University College London Hospital in the U.K., said in a news release.

“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 jeopardize cancer control,” Shaw added.

Impotence and incontinence are well-known potential side-effects of prostate cancer surgery.

In recent years, robotic surgery technology has provided surgeons the precision to spare the prostate nerves, but it can be difficult to determine whether leaving these nerves in place also leaves behind some cancer cells, researchers noted.

In many cases, particularly with advanced prostate tumors, surgeons will err on the side of caution and forego nerve sparing to make sure all cancer is removed, researchers said.

That’s why they developed NeuroSAFE, which enables doctors to check in the middle of an operation whether more tissue needs to be removed, including the prostate nerves.

In the technique, the surgeon extracts the prostate gland while preserving as much nerve tissue around it as possible, researchers explained.

The prostate is then flash-frozen, and samples are examined by a pathologist while the surgery is still underway.

If cancer is found at the edges of the prostate, near the site of key nerves, surgeons can choose to sacrifice the nerves and achieve complete removal of cancer cells. Otherwise, they can finish up the operation with those nerves still intact.

The research team tested NeuroSAFE in a clinical trial run across five U.K. hospitals, involving 344 men diagnosed with prostate cancer and slated for prostate removal.

Half were randomly assigned to receive NeuroSAFE during their operation, while the other half had standard surgery.

A year after surgery, 39% of men treated with NeuroSAFE had no or mild erectile dysfunction, compared with 23% among men who received standard surgery, results show.

Likewise, only 38% of men treated with NeuroSAFE had severe erectile dysfunction, compared with 56% of those who had standard surgery.

The new technique did not affect men’s risk of incontinence, researchers said. However, NeuroSAFE patients who recovered urinary control did so faster than those who had standard surgery.

“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,” researcher Dr. Ricardo Almeida-Magana, a research fellow at University College London, said in a news release.

“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,” he added.

Shaw noted that NeuroSAFE isn't suitable for all.

“NeuroSAFE wouldn’t be appropriate for all patients, as many can safely have nerve-sparing surgery using standard robotic techniques,” he noted. “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.”

However, researchers said more study is needed to track longer-term cancer outcomes among patients treated with NeuroSAFE.

More information

The American Cancer Society has more about prostate cancer surgery.

SOURCE: European Association of Urology, news release, March 24, 2025