The more accurate form of prostate cancer surgery almost doubles the chances of men maintaining erectile function compared to standard surgery, according to the first comprehensive trial of the procedure.
Doctors from five UK hospitals evaluated surgical approaches that are believed to be responsible for the production of erections, maintaining key nerves running through the outer layer of the prostate.
It is known as Neuropathythe procedure involves checking prostate tissue removed from the patient while the surgery is underway. If the examination suggests that the tumor has been removed, the nerve-containing outer layer of the prostate can be left intact to reduce the risk of erection problems in the patient.
Professor Gregshaw, a trial lead and consultant urologist at the NHS Foundation Trust at University College London Hospital, said:
Prostate cancer is the most common cancer in men in the UK, with 50,000 cases being diagnosed each year. Around the world, nearly 1.5 million men have been diagnosed and 375,000 deaths are killed annually. This disease is most common among people over 50 and does not cause symptoms in the early stages, so it is often referred to as silent killers.
The recent development of robotic surgery has enabled doctors to perform accurate “ganglion” surgery in patients with prostate cancer. This involves removing the diseased prostate while the outer layer and nerves leave the nerves passing through them.
However, doctors need to make sure that cancer cells are not left behind, and this can be difficult to assess. If cancer progresses, the surgeon will make mistakes on the aspects of attention and remove the prostate in the outer layer, reducing the risk of tumor cells and disease returning.
In the neurotic procedure, the doctor saves as much nerve tissue as possible, while removing the prostate. The prostate slices are then frozen, stained and tested for cancer cells. If the tumor reaches the surface of the prostate, it may be necessary to remove the outer layer and its nerves. However, if the tumor is deficient, the surgery is considered complete.
The trial evaluated 344 men with prostate cancer who had no history of erectile dysfunction. Half had neurotic surgery and half had standard surgery. One year later, 56% of men who underwent standard surgery reported severe erectile dysfunction, compared to 38% who underwent neuropathic surgery.
Less than a quarter (23%) who underwent standard surgery reported no mild erectile dysfunction or mild erectile dysfunction compared to 39% who underwent neurotic treatment. Details were presented at the 2025 European Urology Conference in Madrid and published in the article. Lancet Oncology.
“We are a resident of a prostate cancer,” said Dr. Matthew Hobbs, research director for the UK. “Prostate cancer surgery is a life-saving option for many men, but it is a major procedure that can cause side effects like erection problems.
“This study is promising and provides evidence that innovative types of surgery can reduce erectile dysfunction in some men. However, further research is needed to prove whether neurosis is as effective as traditional techniques in providing a complete treatment.
“We also need to understand exactly which men can benefit from this new technique. Importantly, this technique can be distributed on a large scale across the NHS, making it accessible to men in the UK.”
