The safest surgery for prostate cancer

If there's one thing a man fears more than a prostate cancer diagnosis, it's the collateral damage caused by surgical intervention. Surgery saves lives, but there's also a risk that the patient will later develop erection problems and incontinence .

At the recent European Congress of Urology, held in Madrid, a British medical team presented the results of a new, more precise surgical technique that doubles the chances of preserving erectile function compared to standard surgery. These optimistic results are from a clinical trial conducted in five British hospitals and coordinated by the NHS University College London. The procedure, known as NeuroSafe , was tested. This procedure involves examining the prostate tissue removed from the patient during surgery to ensure that the outer layer of the prostate, which contains the nerves linked to erection, is not touched. The results, involving 344 men, have been published in the medical journal The Lancet.

NeuroSafe provides key information during surgery that allows urologists to know how far to go without causing more damage than necessary.

Robotic surgery had greatly reduced the risk of side effects in urological procedures. With greater precision, Da Vinci -type robots remove the diseased prostate, leaving the outer layers and the nerves that run through them untouched. However, the question surgeons face is how far to go to avoid leaving cancer cells that would cause the cancer to recur. And this is what the new procedure changes. Doctors remove the prostate, preserving as much surrounding nerve tissue as possible. Then, to ensure no tumor cells are missed, sections of the gland are frozen, stained, and examined for tumor cells.

If the tumor reaches the surface, it will be necessary to remove the outer layers and nerves. However, if it's less invasive, further removal isn't necessary. Without this option, surgeons often end up removing unnecessary tissue purely as a precaution.

The clinical trial presented in Madrid shows that less than a quarter (23%) of those who underwent standard surgery reported having no erectile dysfunction or having had only mild erectile dysfunction, compared to 39% of those who underwent NeuroSafe.

Alberto Pérez Lanzac, medical director of APL Urology and head of the Urology Department at Vithas Madrid Arturo Soria University Hospital, Vithas International, considers the technique "promising," but asks for more time to assess whether it is as effective as traditional procedures in providing a complete cure. "The evidence is still limited. More well-designed studies like this one and a larger number of treated patients are needed to determine who might benefit and evaluate the results," he believes.

Meanwhile, Pérez Lanzac is optimistic about other procedures already being performed. He asserts that new techniques have emerged in recent years that have been reducing the risk of side effects, both in sexual and urinary function. One of these is focal therapy, which allows for limited treatment of the cancerous focus. According to its results, it eliminates the cancer with low rates of side effects. It is demonstrating very good results for urinary continence and erectile function.

This type of intervention relies on nuclear magnetic resonance (which provides highly precise images of the affected areas) and transperineal fusion biopsy (which defines the exact location of the tumor). Focal therapy is minimally invasive and only requires a 24-hour hospital stay. However, it is only indicated in low-risk cases, i.e., small and localized tumors. It should be noted that if the cancer recurs, the disease can be treated again with this same technique, although other available treatment alternatives may be available if the patient so desires.