Prostate cancer check doubles proportion of men who keep erectile function

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) led the study, which will be presented at the European Association of Urology Congress in Madrid 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.

During cancer surgery, the prostate is removed while the nerves are left intact.

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, they know 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.

Professor Greg Shaw, trial lead from UCL and consultant urologist at UCLH, said some younger men in particular worry about surgery causing impotence and incontinence.

He 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.

“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.

“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 white counterparts.

The trial ran at five UK 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 more men will be able to access NeuroSafe on the NHS as long as the right pathology support is available.

He told the PA news agency: “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.”

Dr Ricardo Almeida-Magana, from UCL, 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.”

Dr Matthew Hobbs, director of research at Prostate Cancer UK, said: “A major challenge we face is how to cure men but also ensure they can live life to the full afterwards.

“This study is promising and provides evidence that innovative types of surgery can reduce erectile dysfunction in some men — however more research is needed to prove whether NeuroSafe is as effective as traditional techniques at delivering a complete cure.

“We also need to understand exactly which men could benefit from this new technique and, crucially, whether this technique could be delivered at scale across the NHS to make it accessible to men across the UK.”