A groundbreaking new technique in prostate cancer surgery offers hope to millions of men worldwide by nearly doubling the chances of retaining erectile function after treatment.
Prostate cancer is the most common form of cancer in men in England, with 50,000 cases diagnosed each year. The disease is most common in over-50s and often referred to as a ‘silent killer’ because it causes no symptoms in the early stages.
Preserving Nerves for Better Erectile Function
Recent developments in robotic surgery have allowed doctors to perform precision ‘nerve-sparing’ operations in prostate cancer patients. This involves removing the diseased prostate while leaving the outer layers and the nerves running through them. However, assessing whether cancer cells are left behind can be difficult, and surgeons may err on the side of caution by removing the prostate with its outer layers.
The ‘NeuroSafe procedure’ addresses this challenge by removing the prostate while preserving as much nerve tissue around it as possible. Slices of the prostate are then frozen, stained, and examined for cancer cells. If the tumour reaches the surface of the prostate, the outer layers and their nerves may need to be removed. But if the tumour stops short, the surgery is considered complete.
Neurosurgery has made tremendous progress since its inception in the late 19th century.
The first successful brain surgery was performed by Harvey Cushing in 1900, marking a significant milestone in the field.
Advancements in imaging technologies, such as MRI and CT scans, have enabled neurosurgeons to visualize complex brain structures with greater accuracy.
Modern techniques like stereotactic surgery and minimally invasive procedures have reduced recovery times and improved patient outcomes.
According to the American Association of Neurological Surgeons, there are over 17,000 board-certified neurosurgeons in the United States alone.
Breakthrough Trial Results
A comprehensive trial assessing 344 men with prostate cancer who had no history of erectile dysfunction found that the NeuroSafe procedure nearly doubles the chances of men retaining erectile function afterwards compared with standard surgery. A year later, 56% of men who had standard surgery reported severe erectile dysfunction, compared to ‘38% who had NeuroSafe surgery’.
Prostate cancer treatment depends on the stage and aggressiveness of the disease.
For early-stage prostate cancer, active surveillance or watchful waiting may be recommended.
This involves monitoring the cancer with regular check-ups and biopsies to determine if treatment is necessary.
Surgery, radiation therapy, and hormone therapy are common treatments for localized prostate cancer.
Advanced prostate cancer often requires a combination of these therapies.
According to the American Cancer Society, more than 191,000 men are diagnosed with prostate cancer each year in the United States.
Less than a quarter (23%) of those who had standard surgery reported no or only mild erectile dysfunction, compared to 39% who had the NeuroSafe procedure. These results were presented at the 2025 European Association of Urology congress in Madrid and published in ‘The Lancet Oncology’.
Erectile function is a complex process involving multiple physiological systems.
It begins with sexual arousal, which stimulates the release of neurotransmitters such as acetylcholine and dopamine.
These chemicals trigger the release of nitric oxide in the penis, leading to smooth muscle relaxation and increased blood flow.
The resulting engorgement of spongy tissue enables erection.
Factors affecting erectile function include age, lifestyle, medical conditions, and medication side effects.
Implications and Future Directions
The trial lead, Prof Greg Shaw, stated that the NeuroSafe procedure gives surgeons feedback during the surgery to give them the certainty they need to spare as many nerves as possible. This increases men’s hope of recovering their sexual potency after their cancer is surgically removed. However, more research is needed to prove whether NeuroSafe is as effective as traditional techniques at delivering a complete cure.
Dr Matthew Hobbs, director of research at Prostate Cancer UK, highlighted the importance of understanding which men could benefit from this new technique and ensuring its accessibility across the NHS in the UK.
- theguardian.com | Prostate cancer surgery breakthrough offers hope for erectile function
