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April 2025 | George M. Pikler, M.D., Ph.D., FACP, Lead Oncology Advocate N1X10

New Prostate Cancer Surgery Improves Patient-Reported Functional Outcomes

Robot-assisted radical prostatectomy (RARP) is the most frequently performed surgical treatment for non-metastatic prostate cancer but has a significant risk of post-operative urinary incontinence, erectile dysfunction, and the absence of semen. Surgical damage to the plexus of parasympathetic nerve fibers, known as the neuro-vascular bundle, that lies in microscopic proximity to the postero-lateral surface of the prostate capsule is the main driver of these adverse outcomes. Preserving the neuro-vascular bundle by dissecting close to the prostate during RARP, known as nerve-sparing, has been correlated with improved erectile function, urinary continence, and quality of life recovery.

A new type of prostate cancer surgery aims to preserve the periprostatic neurovascular bundles. Known as NeuroSafe, it involves a standardized frozen section analysis of prostate tissue removed from the patient while the operation is under way to determine the boundaries of the tumor. If the examination suggests the tumor has been removed, the nerve-containing outer layer of the prostate can be left intact, increasing the chances of the patient retaining erectile function after the operation.

Surgeons at five United Kingdom hospitals, conducted the first patient-blinded, randomised, controlled phase 3 trial in prostate cancer surgery to assess the effect of NeuroSAFE-guided robot-assisted radical prostatectomy (RARP) versus standard RARP on erectile function and urinary continence. The trial (1) included 344 men with prostate cancer who had no history of erectile dysfunction. Half underwent the NeuroSafe procedure and half underwent standard surgery. A year later, 56% of men who had standard surgery reported severe erectile dysfunction, compared with 38% who had NeuroSafe surgery. Less than a quarter (23%) who had standard surgery reported no or only mild erectile dysfunction, compared with 39% who had the NeuroSafe procedure.

The improvement in erectile function observed in the NeuroSAFE group is likely to be attributable to higher rates of bilateral nerve-sparing, since the established association between nerve-sparing and erectile function recovery is well recognized.

This trial confirms the efficacy of the NeuroSAFE technique to improve functional quality of life after RARP in patients with good preoperative urinary and erectile function.

(1) The Lancet Oncology. 2025, 26 (4): 447-458
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Erica

Erica Cross, PA

PA

Erica is a board certified Physician Assistant. She obtained her Master’s degree in Physician Assistant studies from Our Lady of the Lake College in Baton Rouge, LA. She began practicing in 2011 and has worked clinically in Orthopedics and Dermatology. The majority of her career has been spent in a Dermatology practice where she assisted in Mohs surgery, treating various types of skin cancer. She also teaches in the medical simulation department at the University of South Alabama and enjoys every aspect of medical education.