A modified prostate cancer surgery technique leaves significantly more men with preserved erectile function compared to standard surgeries, UK researchers reported on Monday at the European Association of Urology Congress in Madrid.
The nerves that run through the prostate's outer layers are thought to be responsible for producing erections. Whether these nerves can be left intact without leaving some cancer cells behind has been hard for surgeons to discern, and they tend to err on the side of safety and remove the nerves if unsure.
In a randomized trial, researchers assessed the benefit of adding an extra step, called neurovascular structure-adjacent frozen-section examination, or NeuroSAFE, in which pathologists examine samples of nerve-adjacent prostate tissue while the patient is on the operating table. If the analysis doesn't find cancer cells, the nerves are left intact.
Researchers studied 344 patients undergoing robot-assisted radical prostatectomy who had no prior issues with erectile dysfunction. One year later, 39% of those in the NeuroSAFE group had no or mild erectile dysfunction, compared to 23% of those who had standard surgery, according to a report of the study published in The Lancet Oncology.
Rates of severe erectile dysfunction were 38% in the NeuroSAFE group versus 56% after standard surgery.
The technique did not increase the overall proportion of patients who were fully continent at 12 months, but NeuroSAFE patients who recovered their urinary control did so faster than patients who underwent standard surgery.
NeuroSAFE's real-time evaluation "opens up the option of nerve-sparing surgery for many more men, without compromising on the chances of controlling the cancer," study leader Dr. Ricardo Almeida-Magana of University College London said in a statement.
Dr. Derya Tilki of the Martini Klinik Prostate Cancer Center in Hamburg, Germany, where the NeuroSAFE technique was developed decades ago, noted that the trial was not designed to determine longer-term cancer outcomes. "But based on the data we have from using the technique for over 20 years, NeuroSAFE does not appear to affect these."
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