By Lila Rouland | Published on November 24, 2025 | 3 min readRadical prostatectomy (RP) remains a key
treatment for men with
localized prostate cancer. However, it is associated
with two major side effects:
urinary incontinence and
erectile dysfunction,
both of which significantly affect
postoperative quality of life. Nerve-sparing
(NS) techniques allow partial preservation of erectile nerves to limit these
complications, but they carry a greater risk of positive surgical margins,
particularly in cases of extracapsular tumor extension.
The
NeuroSAFE technique (Neurovascular
Structure-Adjacent Frozen Section Examination) enables intraoperative analysis
of margins near the neurovascular bundles. Its goal is to
increase the use of
nerve-sparing without compromising
oncologic safety. The Dutch study presented
here evaluates, in more than 1,000 patients,
postoperative functional outcomes
on
continence and
erectile function following systematic adoption of NeuroSAFE
in a high-volume surgical center.
Better functional recovery with NeuroSAFE?
Cohort and methods The study included
1,034 men who underwent
robot-assisted radical prostatectomy between September 2018 and February 2021.
Among them,
987 (95.5%) benefited from the NeuroSAFE protocol. Continence and
erectile function (EF) outcomes were collected using
validated questionnaires
(EPIC-26, ICIQ-UI SF, IIEF-5) before surgery and at 6 months, 1 year, and
annually thereafter.
Increased nerve preservation and favorable
continence rates Most patients underwent nerve-sparing surgery:
55% bilaterally and 30% unilaterally, versus 15% without NS. Among men without
preoperative incontinence, 92% reported using 0–1 urinary protection per day at
1 year, and 94% at 2 years. These rates rose to 96% for patients with NS
surgery, compared with only 78% for those without NS at the 2-year follow-up.
Erectile function: partial but meaningful
improvement Among patients with good preoperative erectile
function, 45% retained good or intermediate erectile function two years after
RP. EF recovery was clearly correlated with the type of nerve preservation: 49%
in the bilateral NS group versus 15% in the non-NS group. Qualitatively, only
20–28% of men recovered erections deemed sufficient for sexual intercourse,
depending on the questionnaire used (EPIC-26 or IIEF-5).
Limitations and potential biases Response rates to the functional questionnaires
were limited (60% for EF and 63% for continence), which may introduce a
selection bias. The absence of a control group without NeuroSAFE prevents
direct comparison, although results
exceed national Dutch benchmarks.
Additionally, the cohort was older (median age: 68 years) than in several
comparative studies.
Toward broader adoption of NeuroSAFE?
This large prospective study demonstrates that
introducing the
NeuroSAFE technique in robotic radical prostatectomy
significantly increases
nerve-sparing rates, with clinically meaningful
improvements in urinary continence and erectile function at mid-term follow-up.
Results show that
continence recovery reaches
94% at 2 years, and approximately one in two men retains satisfactory erectile
function after nerve-sparing surgery, particularly when bilateral. These
findings support wider integration of the NeuroSAFE approach in centers
performing RP, provided that rapid pathology processing and experienced
surgical teams are available.
Additional studies, ideally comparative and
multicenter, will better quantify NeuroSAFE’s direct impact on functional and
oncologic outcomes while assessing its
cost-effectiveness in standard prostate
cancer management.
Read next: Prostatectomy or SBRT: which treatment better preserves quality of life?
About the author – Lila RoulandDoctor of Oncology, specialized in Biotechnology and Management
