Twice as many men recover erectile function after improved prostate cancer surgery

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 which preserves the nerves that run through the prostate’s outer layers during prostate removal. These nerves are thought to be responsible for producing erections. 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.
 
UCLH consultant urologist Professor Greg Shaw 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. 
 
“NeuroSAFE wouldn’t be appropriate for all patients, as many can safely have nerve-sparing surgery using standard robotic techniques. But for younger patients and those who wouldn’t normally be seen as eligible for nerve-sparing surgery, it offers them a greater chance to hold onto their quality of life.”
 
The NeuroSAFE PROOF trial is the first randomised, controlled trial to fully evaluate the impact of the NeuroSAFE technique on erectile dysfunction and urinary incontinence – two of the most common side effects of prostate surgery.
 
The trial analysed outcomes for 344 men diagnosed with prostate cancer who were due to undergo prostate removal and who had no prior issues with erectile dysfunction. Half were randomised to receive NeuroSAFE during their operation and half had standard surgery. 
 
One of the patients who took part in the clinical trial was Courtney Ming, 62, of East London. Courtney said he had been advised to have surgery at his local hospital when he requested a second opinion and was referred to UCLH.
 
The decision to request a second opinion led him to “Professor Greg Shaw, who told me he was pioneering nerve-sparing surgery, and I consider myself blessed to have found him. He explained that his approach was different, focusing on monitoring and managing the cancer rather than jumping straight into surgery.”
 
Courtney was monitored for three years before he had surgery. “I had a month to mentally prepare for surgery. But I was fortunate. The preparation and guidance from my medical team were invaluable. A year before surgery, they had us attending meetings, learning about diet, exercise, and everything we needed to do to improve our recovery. I did my pelvic floor exercises religiously, knowing that it would make a difference.
 
“My priority was survival. Some of my colleagues, however, were more concerned about their sex life before anything else. I told them, "Come on, think about your kids, your wife, your life!" Everyone's perspective is different, but to me, the choice was clear. If I left the cancer untreated, it could spread to my lymph nodes and beyond. The priority had to be getting rid of it.
 
“Going into surgery, there was no guarantee. The doctors made it clear that if my nerves contained cancer cells, they would have to remove them, and there would be no going back. Thankfully, the MRI and scans showed that my nerves were clear. That meant they could be spared, which was a huge relief. But it was still a gamble.
 
“Recovery wasn’t quick. There’s no such thing as a quick fix for something like this. It took months upon months, but there were signs that I was heading in the right direction. The preparation helped immensely, and looking back, I appreciate that they covered everything—from diet to exercise to mental preparedness. I still have an untouched pack of incontinence pads in my wardrobe as a souvenir—a reminder that my efforts paid off.
 
“Now, every year, I do my blood test, and seeing my PSA at 0.01 is a clear indicator that life is good. As a 62-year-old man, my quality of life is still high. If I had to put a percentage on it, I’d say I’m at 85–90% of where I was before surgery. Some days, I feel even better. Most importantly, I’m alive, healthy, and still enjoying life.
 
“One of the scariest things about this journey was that I had no symptoms. No pain, no waking up in the night to use the bathroom—nothing. Prostate cancer is a silent assassin, and that’s why awareness is so important. I’m grateful I listened to my coworkers back in 2015. If I hadn’t, I might not be here to share my story today.”
 
The study was funded by the National Institute for Health and Care Research, The Rosetrees Foundation, St Peter’s Charitable Trust and the Jon Moulton Charity Trust.

This research is part of a larger body of research at UCLH, some of which is supported by UCLH Charity, through generous support from major donors and the UCLH Charity Cancer Fund. The research is exploring how mapping anatomical structures of prostate cancer patients, and producing personalised surgical “roadmaps”, could better inform surgical approaches. Some of this work features in the NeuroSAFE trial and is another example of the ongoing work in precision robotic surgery at UCLH today.
 
The authors would like to acknowledge the support of surgical teams across all participating sites, including the UCLH robotic urology team which also consists of Justin Collins, Nicolo De Luyk, Anand Kelkar, Senthil Nathan, Prash Patel, Prabs Rajan, Prasanna Sooriakumaran, and Ashwin Sridhar.