A technique to improve the precision of prostate cancer surgery means that almost twice as many men preserve their erectile function compared to those undergoing standard surgery, according to results from a clinical trial led by researchers from UCL and UCLH.
The results of the NeuroSAFE PROOF trial, presented at the 2025 European Association of Urology (EAU) Congress in Madrid and published in The Lancet Oncology, raise the prospect of major quality of life improvements for men undergoing surgery for prostate cancer, which can often result in erectile dysfunction and urinary incontinence.
The trial evaluated a method (called NeuroSAFE) of preserving the nerves that run through the prostate’s outer layers, which are thought to be responsible for producing erections, during prostate removal. The pioneering method includes an additional test to ensure that all of the cancerous cells are removed, so that preserving the nerves does not risk the surgery’s success.
In recent years, preservation of these nerves has been made possible by robotic surgery technology1 that gives the surgeon the precision required to peel off and retain the outermost layers of the prostate where the nerves are situated, a process known as ‘nerve sparing’.
However, during standard surgery it can be difficult to determine whether retaining these outer layers risks leaving some cancerous cells behind. In many cases, especially where the tumour is most advanced, surgeons will err on the side of caution and forego nerve sparing to ensure that all of the patient’s cancer is removed.
NeuroSAFE enables them to check during the operation whether further tissue removal is needed or not.
Professor Greg Shaw, the trial lead from UCL Surgery & Interventional Science and Consultant Urologist at UCLH, 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.
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