Innovative prostate surgery technology doubles the chances of men retaining sexual function

According to a landmark UK study published on Monday Lancet Oncology.

The findings of the Neurosafe validation trial presented at the European Urology Conference in Madrid in 2025 suggest that changes in quality of life in thousands of men facing prostate cancer surgery may be at sea.

Researchers at UCL and UCL found that the use of neuroprotective methods significantly improved erectile function and early urinary potential recovery without compromising cancer control during robot-assisted radical prostatectomy (RARP).

“Our results show that by using Neurosafe, you can hardly have to face twice as many erectile function that may change your life,” said Greg Shaw, head of trials at UCL Surgery & Interventional Sciences and UCLH’s consultant urologist.

The randomized controlled trial involved 344 men in five British hospitals with good erectile function before surgery. Participants were randomly assigned to standard RARP or Neurosafe-guided RARP, and the researchers followed up the results 12 months after the surgery.

How Neurosafe technology works

Neurosafe technology developed in Germany, but not widely used outside its country of origin, allows surgeons to retain subtle nerve bundles around the prostate that controls erectile function.

During the procedure, surgeons aim to maintain as much nerve tissue as possible while removing the prostate. The extracted glands are then flashed and examined by a pathologist during the procedure. If cancer cells are detected at the edge near the critical nerve, the surgeon can remove other tissues to ensure complete removal of the tumor. If cancer is not found, the appropriate neurological treatment can be confirmed.

This real-time assessment provides a definite, standard preoperative planning approach that is unavailable, allowing for neurotherapy surgery to be performed for more patients without compromising cancer treatment.

“Neurosafe provides surgeons with a real-time assessment of surgical safety,” explains Dr. Ricardo Almeida-Magana, lead author of the Lancet Oncology paper. “In standard robotic surgery, surgeons determine whether to select neuroretention based on MRI scans, digital rectal examinations, and biopsy results before the surgery. However, while these methods can provide guidance, NeuroSafe provides certainty.”

Huge differences in results

Surprising results: 12 months after surgery, 39% of men undergoing neuroprotective surgery had no or mild erectile dysfunction, compared with only 23% in the standard surgery group. Severe erectile dysfunction affects only 38% of neurological protection patients, compared with 56% of those receiving standard treatment.

At the 12-month standard, the mean International Index of Erectile Function (IIEF-5) score was 12.7 in the Neurosafe group and 9.7 in the standard RARP group, representing a significant improvement.

Although both groups eventually achieved similar urinary rates with one year mark, patients undergoing neuroprotective surgery recovered urinary tract control faster, which is a meaningful quality of life advantage in challenging postoperative periods.

The study also found that patients who benefited the most from neurological protection methods would not usually be treated with neurotherapy based on traditional preoperative assessments.

“This is an involved program that requires expertise, but is not expensive, especially given the benefits provided by the patient, and most importantly, it does not harm cancer control,” Professor Shaw notes. “Neurosafe is not suitable for all patients, as many people can safely perform neurotherapy surgery using standard robotics. However, for young patients and young patients who are not usually eligible for neurotherapy surgery, it provides them with a greater opportunity to maintain their quality of life.”

From Germany to global practice?

The technology has been used for more than a decade at the Martinique Prostate Cancer Center in Hamburg, Germany, which was initially developed but has not been widely adopted elsewhere despite promising observational studies.

When commenting on the results, Professor Derya Tilki from Martini Klinik was not involved in the trial, saying: “We use Neurosafe for most of the 2500 prostate cancer patients every year, and the majority of the 2500 prostate cancer patients we treat each year, and it’s great to see the technology evaluated in the first randomized controlled trial. We will allow all results from NEUROSFE to recover, just like we do.

The trial also addressed concerns about cancer control, showing no significant differences in early tumor outcomes between the two groups. Although 9% of Neurosafe patients experienced PSA persistent or biochemical relapses after 12 months, compared with 6% in the standard group, the researchers noted that these differences were not statistically significant for determining outcomes for long-term cancer.

Impact on practice

Prior to this trial, the evidence supporting Neurosafe was limited to retrospective studies, with many studies experiencing moderate to severe risk of bias. This randomized controlled trial provides the highest quality evidence to date that the technology improves functional outcomes.

The study authors believe that prostate cancer care guidelines should be updated to reflect these findings.

The study has obvious advantages, including its high proportion of Black and African Caribbean populations – groups with higher risk of early prostate cancer may particularly benefit from functional technology.

However, the researchers acknowledge that there are several limitations. Most procedures were conducted at a center, and the 12-month follow-up period of the trial ruled out clear conclusions about long-term cancer control. Additionally, Neurosafe technology requires dedicated staff and increases surgical time, which may limit widespread adoption in resource constraint settings.

Since prostate cancer remains the most common cancer in men and radical prostatectomy is the standard treatment option, these findings may affect thousands of patients each year. The prospect of maintaining sexual function while successfully treating cancer is an important step in addressing one of the most worrying side effects in prostate cancer treatment.

The study was funded by the National Institute of Health and Care, the Rose Foundation, the St. Peter Charitable Trust and the Jon Moulton Charitable Trust.