A technique is being trialled by London surgeons to reduce the risk of men losing their sexual potency from prostate cancer surgery.
The “NeuroSAFE” procedure aims to minimise the chance of having to remove the nerves around the prostate gland, thereby preserving a man’s ability to have sex.
Surgeons hope this will encourage younger men with prostate cancer to agree to an attempted cure with surgery.
Prostate cancer is the most common cancer in men in the UK, with almost 50,000 new cases diagnosed annually. It kills about 12,000 a year but if caught early the chances of a cure are very good.
The trial is being led by consultant urological surgeon Greg Shaw at University College London Hospitals in Marylebone. The procedure originated in Germany and has been performed during robotic prostate surgery for the past five or six years.
Mr Shaw, who uses a surgical robot to remove a prostate, said he had launched the trial after seeing two young patients decline surgery only for their cancer to become untreatable.
Black men in their forties and fifties are at higher risk of aggressive prostate cancer.
Mr Shaw said: “They chose not to have surgery because they were so scared of the side-effects. But the cancer spread, meaning it was no longer curable. They are going to die of that cancer. That was the impetus for the trial.”
The new procedure involves the surgeon leaving behind the potency nerves in the outer covering of the prostate whilst removing the walnut-sized gland itself.
The removed prostate is analysed under a microscope by a pathologist while the patient remains under anaesthetic on the operating table.
If no cancer is detected in the area adjoining the nerves, the “all clear” is given and the operation is completed. If cancer is found, then the surgeon removes the nerves.
“The tendency is to not spare the nerves if there is thought to be a risk of leaving cancer behind,” Mr Shaw said.
“There is a strong rationale to do everything we can to spare the nerves when safe to do so, particularly where patients are so young and have got a lot to lose.
“We know that nerve-sparing works. The more nerve tissue is left behind, the greater a man’s chances of being potent after surgery. If we can’t leave the nerves at all, they’re extremely unlikely to be potent, even with Viagra.”
About 50 men have taken part in the first stage of the trial. Half have undergone the NeuroSAFE technique, and only “a handful” of them have required removal of their nerve bundles.
But it costs £1,000 to have a pathologist and theatre technicians on standby. The trial aims to establish whether this is value for money. The next stage, due to start this month, is to secure funding to recruit up to 400 patients and expand the trial to Bristol and Sheffield.