A surgical technique called NeuroSafe almost doubles the chances that men will retain erectile function after prostate cancer surgery, according to the first large-scale clinical trial of the procedure. Results presented at the 2025 European Association of Urology congress in Madrid and published in Lancet Oncology offer real hope to the hundreds of thousands of men diagnosed with prostate cancer each year who face a painful trade-off between curing their cancer and preserving their quality of life.
At a glance
- NeuroSafe surgery: A technique where surgeons freeze and examine slices of prostate tissue mid-operation to confirm the tumor has been fully removed — allowing them to spare the surrounding nerve tissue if it’s safe to do so.
- Trial results: Among 344 men with no prior erectile dysfunction, only 38% of NeuroSafe patients reported severe erectile dysfunction one year after surgery, compared with 56% of men who received standard surgery.
- Erectile function outcomes: 39% of NeuroSafe patients reported no or only mild erectile dysfunction at one year, nearly double the 23% who reported the same after standard surgery.
How NeuroSafe prostate surgery works
The prostate is surrounded by a thin outer layer threaded with nerves believed to control erectile function. Standard surgery removes the prostate along with that layer to make sure no cancer cells are left behind — a cautious approach that often damages or destroys those nerves in the process.
NeuroSafe takes a different path. Surgeons remove the prostate and then immediately freeze, stain, and examine thin slices of the tissue while the patient is still on the operating table. If the tumor hasn’t reached the outer edge of the prostate, the nerve-containing layer can be left intact. If it has, surgeons remove it — but at least the decision is based on real-time evidence rather than estimation.
Professor Greg Shaw, the trial lead and a consultant urologist at University College London Hospitals NHS Foundation Trust, described the approach as giving surgeons “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.”
Why this matters for men with prostate cancer
Prostate cancer is the most common cancer in men in England, with 50,000 new cases diagnosed every year. Globally, nearly 1.5 million men are diagnosed annually and 375,000 die from the disease each year. It disproportionately affects men over 50 and is often detected late because it produces no symptoms in its early stages.
Surgery can be life-saving. But for many men, the prospect of permanent erectile dysfunction is a serious concern that shapes treatment decisions — sometimes leading men to delay or avoid surgery altogether. A technique that meaningfully reduces that risk without compromising cancer control could shift that calculation for a significant number of patients.
Advances in robotic-assisted surgery have already improved surgeons’ precision in prostate procedures, making nerve-sparing operations more feasible. NeuroSafe builds on that capability by adding an intraoperative feedback loop — a real-time tissue check — that removes much of the guesswork that previously forced surgeons toward more aggressive removal.
Part of a broader shift in cancer care
This trial fits into a wider pattern of cancer medicine moving toward treatments that don’t just extend life but protect how that life is lived. Research into precision surgical techniques has been reshaping what’s possible across multiple cancer types, and prostate cancer surgery is catching up.
The five hospitals involved in this trial are all NHS institutions, signaling that this isn’t just experimental medicine confined to private clinics. The Lancet Oncology publication gives the findings strong scientific standing, and the involvement of Prostate Cancer UK in evaluating the results adds credibility from the patient advocacy side.
What still needs to happen
Dr. Matthew Hobbs, director of research at Prostate Cancer UK, called the results promising but flagged key open questions: researchers still need to confirm that NeuroSafe is as effective as standard surgery at achieving a complete cure, and it’s not yet clear which patients are the best candidates for the technique.
The trial measured erectile function at one year, but the full picture of cure rates and recurrence will take more time and follow-up to establish. Rolling the procedure out at scale across the NHS would also present logistical and resourcing challenges that remain unresolved. The one-year results are encouraging; whether the nerve-sparing approach holds up over a decade is still an open question.
For now, though, the evidence is clear: a surgical technique that nearly doubles the odds of preserving erectile function — without requiring men to choose between cancer treatment and quality of life — is a meaningful advance worth watching closely.
Read more
For more on this story, see: The Independent
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