A more precise form of prostate cancer surgery nearly doubles the chances of men retaining erectile function afterwards compared with standard surgery, according to the first comprehensive trial of the procedure.
Doctors in five UK hospitals assessed the surgical approach that aims to preserve crucial nerves that run through the outer layer of the prostate and are thought to be responsible for producing erections.
Known as NeuroSafe, the procedure involves checking prostate tissue removed from the patient while the operation is under way. If the examination suggests the tumour has been removed, the nerve-containing outer layer of the prostate can be left intact, reducing the patient’s risk of erectile problems.
Prof Greg Shaw, the trial lead and a consultant urologist at University College London hospitals NHS foundation trust, said: “This procedure gives surgeons feedback during the surgery to give them the certainty they need to spare as many nerves as possible and give men increased hope of recovering their sexual potency after their cancer is surgically removed.”
Prostate cancer is the most common form of cancer in men in England, with 50,000 cases diagnosed each year. Worldwide, nearly 1.5 million men are diagnosed and 375,000 die annually. The disease is most common in over-50s and is often called a silent killer because it causes no symptoms in the early stages.
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, doctors must be sure that no cancer cells are left behind, and this can be difficult to assess. If the cancer is advanced, surgeons will err on the side of caution and remove the prostate with its outer layers to reduce the risk of missing any tumour cells and the disease returning.
In the NeuroSafe procedure, doctors remove 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 its nerves may need to be removed. But if the tumour stops short, the surgery is considered complete.
The trial assessed 344 men with prostate cancer who had no history of erectile dysfunction. Half received 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. Details were presented at the 2025 European Association of Urology congress in Madrid and are published in the Lancet Oncology.
Dr Matthew Hobbs, the director of research at Prostate Cancer UK, said: “Prostate cancer surgery is a life-saving option for lots of men, but it’s a major procedure that can cause side-effects like erection problems. 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.”
