When you are considering prostate cancer surgery, the goal is not only to remove the cancer. You also want to understand how treatment may affect your urinary control, sexual function, confidence, and overall quality of life after recovery.
The NeuroSAFE technique was developed to help your surgeon make more precise decisions about nerve preservation during radical prostatectomy. It uses rapid frozen-section analysis during the operation to check whether cancer is present at the surgical margin close to the nerve bundles.
The main benefit of NeuroSAFE is that it provides your surgeon with real-time information during surgery. If the designated frozen section is negative, no secondary resection may be required and the initially preserved nerve bundle can remain in place. If tumour cells are identified at the designated inked nerve-adjacent margin, your surgeon may perform a secondary resection on that side to address the positive margin. This allows your treatment team to balance two important goals: removing the cancer effectively and protecting your quality of life wherever it is safely possible.
Why Nerve Preservation Matters
The nerves involved in erections run very close to the prostate. If you are having prostate cancer surgery, these nerve bundles may be fully preserved, partially preserved, or removed depending on where your cancer is located and how close it is to the nerves.
Preserving these nerves can improve your chances of recovering erectile function after surgery. However, nerve preservation should only be attempted when it is considered safe. Your surgeon must always prioritise removing the cancer effectively.
This is where NeuroSAFE can be valuable for you. It provides your surgeon with additional real-time information during the operation instead of relying only on pre-operative scans and predictions. This can help guide decisions about whether nerve preservation is appropriate on each side of the prostate.
The Main Benefit of NeuroSAFE
The main benefit of NeuroSAFE is that it helps your surgeon maximise safe nerve-sparing during prostate cancer surgery. If you are considering this technique, it is important to understand that the aim is not simply to preserve nerves, but to preserve them only when cancer control remains safe.
During the operation, NeuroSAFE checks the margin near the nerve bundles using rapid frozen-section analysis. If no tumour is identified at the designated frozen-section margin, no secondary resection may be required and the initially preserved nerve bundle can remain in place. If tumour reaches the inked margin, additional adjacent tissue may be removed according to the surgical protocol.
This allows the surgical approach to be adapted according to the intraoperative findings. Instead of relying solely on pre-operative information, your surgeon can use real-time findings to guide decisions. For you, this may provide a more personalised balance between protecting function and removing the cancer effectively.
Better Balance Between Cancer Control and Function
One of the biggest challenges in prostate cancer surgery is finding the right balance between removing the cancer and protecting your quality of life. If more tissue needs to be removed, it may improve cancer clearance in some situations, but it can also affect the nerves involved in recovery.
NeuroSAFE helps your surgeon make this balance more precisely by providing targeted pathology information during your operation. If you are considering this technique, it is important to understand that it is not designed to put nerve preservation before cancer safety.
Instead, NeuroSAFE helps your surgeon decide when nerve preservation is appropriate and when wider tissue removal may be safer. This can be especially useful when your cancer is close to the edge of the prostate and the decision is more difficult.
Improved Confidence During Nerve-Sparing
Without NeuroSAFE, surgeons make nerve-sparing decisions using MRI findings, biopsy results, PSA measurements, clinical assessment and surgical judgement. These factors remain essential, but they cannot always detect microscopic cancer at the surgical edge.
NeuroSAFE adds another layer of information by examining the nerve-adjacent margin while your operation is still taking place. If your surgical team is uncertain about whether nerve preservation is safe, this real-time assessment can provide valuable guidance.
For you as a patient, this means decisions about nerve-sparing are supported by additional evidence rather than relying only on prediction. NeuroSAFE does not remove all uncertainty, but it helps your surgeon make a more informed decision based on what is found during your surgery.
More Personalised Surgery
Prostate cancer is different for every man. If you are considering surgery, factors such as your tumour location, cancer grade, stage, prostate size, erections before treatment, and overall health all help determine the safest approach for you.
NeuroSAFE allows surgery to become more personalised because your surgeon can assess each side of the prostate separately. One side may be suitable for nerve-sparing, while the other side may require wider tissue removal to improve cancer control.
This side-specific approach is one of the practical advantages of NeuroSAFE. Instead of using an all-or-nothing decision, your surgeon can tailor the operation based on your individual cancer pattern. This may help preserve function where it is safe while still focusing on effective cancer treatment.
Potential for Higher Nerve-Sparing Rates
Studies have suggested that NeuroSAFE may increase the number of men who can undergo nerve-sparing surgery. If you are considering this approach, this may include unilateral nerve-sparing, where one nerve bundle is preserved, or bilateral nerve-sparing, where both nerve bundles are preserved when it is considered safe.
A validation study reported that NeuroSAFE enabled more unilateral and bilateral nerve-sparing without worsening surgical margin status or biochemical recurrence outcomes in that group. These findings suggest that real-time margin assessment may help surgeons identify situations where nerve preservation can be safely increased.
For you, the potential benefit is that preserving more nerve tissue may improve the chance of functional recovery after surgery. However, this applies only to suitable patients. Your cancer location, risk level, and surgical findings must always guide the final decision.
NeuroSAFE-Guided vs Standard Robotic Prostatectomy Outcomes
| Outcome | Standard Robotic Prostatectomy | NeuroSAFE-Guided Robotic Prostatectomy | Notes |
| Bilateral Nerve-Sparing | Lower rate; based on pre-op judgement | Higher rate; intraoperative frozen-section supports nerve preservation | Phase 3 trial showed higher nerve-sparing and improved erectile-function outcomes, with longer follow-up needed to confirm long-term oncological impact |
| Erectile Function Recovery | Moderate; dependent on surgeon experience and pre-op function | Improved at 12 months; better patient-reported outcomes in suitable candidates | NeuroSAFE increases chance of functional recovery where safe |
| Positive Surgical Margin Rate | Standard rate | Mixed evidence; phase 3 trial found more small positive margins but similar large or multifocal margins | Longer follow-up is required to understand long-term oncological impact |
| Operating Time | Standard | Slightly longer | Extra time needed for tissue processing and pathology |
| Early Oncological Outcomes | Standard | Maintained | Early evidence reassuring; longer follow-up ongoing |
| Urinary Continence Recovery | Standard | May improve short-term recovery | Depends on anatomy, surgical technique, and post-op rehabilitation |
| Personalised Surgery | Limited by pre-op info | Side-specific nerve-sparing decisions guided by real-time pathology | Allows tailored approach based on tumour proximity to nerves |
Better Chance of Erectile Function Recovery
Erectile function recovery after prostate surgery depends on many factors. If you are considering surgery, your age, erections before treatment, quality of nerve preservation, diabetes, cardiovascular health, smoking history, and rehabilitation support can all influence your recovery.
A randomised trial of NeuroSAFE-guided robot-assisted radical prostatectomy found improved patient-reported erectile function scores at 12 months compared with standard robotic prostatectomy. The benefit was particularly noticeable in men who may not have received bilateral nerve-sparing surgery without NeuroSAFE guidance.
However, NeuroSAFE does not guarantee that you will recover erections after surgery. Its benefit is that it may improve the conditions needed for recovery by helping your surgeon preserve nerves more safely when cancer control allows. Your individual outcome will still depend on your health, cancer characteristics, and recovery process.
Evidence Note
The NeuroSAFE PROOF phase 3 trial recruited 407 men at five NHS hospitals. Of these, 381 underwent surgery and were included in the modified intention-to-treat analysis. The primary 12-month erectile-function outcome was available for 344 participants.
The study included men with non-metastatic prostate cancer who had good erectile function before surgery and had not received previous prostate cancer treatment. The findings are therefore most directly relevant to men who have meaningful erectile function to preserve before prostatectomy.
In the NeuroSAFE PROOF trial population, bilateral nerve-sparing was performed in approximately 82% of men receiving NeuroSAFE-guided surgery compared with 56% receiving standard surgery. At 12 months, the mean IIEF-5 erectile-function score was 12.7 with NeuroSAFE and 9.7 with standard surgery.
Urinary continence scores were better with NeuroSAFE at three months, but the difference was no longer statistically significant at six months.
The early oncological findings require caution. Small positive surgical margins were more frequent with NeuroSAFE, while large or multifocal margins were similar between the groups. Longer follow-up is needed to determine whether there is any meaningful difference in recurrence or later treatment.
Support for Men with Good Pre-Surgery Erections
Men who have good erectile function before prostate surgery may gain particular value from techniques that support nerve preservation. If you have good erections before treatment, there may be more function to protect and potentially recover after surgery.
NeuroSAFE can be helpful when your surgeon wants to preserve the nerves but needs additional reassurance that cancer has not reached the margin beside them. The technique provides extra information during the operation, helping guide decisions about whether nerve preservation is safe.
Your surgeon should discuss your erectile function before surgery because it affects your recovery expectations. If you are considering NeuroSAFE, an honest conversation about your current function, cancer risk, and treatment goals can help you understand whether the technique may offer meaningful benefit for you.
It May Reduce Unnecessary Nerve Removal
Without NeuroSAFE, your surgeon may sometimes remove more tissue around the nerve bundles when cancer risk is uncertain. If you are having prostate surgery, this wider removal may be the safest approach in some situations, but it can also affect the nerves involved in erectile function.
NeuroSAFE may help reduce unnecessary nerve removal by checking whether the margin close to the nerves is clear during the operation. If the pathology result suggests that cancer is not present at the margin, your surgeon may be able to preserve more nerve tissue.
This is one of the benefits that may matter most to you after surgery. NeuroSAFE aims to protect quality of life where possible while still maintaining the priority of safe cancer removal. The decision will always depend on your individual cancer features and surgical findings.
It Allows Immediate Additional Tissue Removal
Another important benefit of NeuroSAFE is that it can identify a positive surgical margin while your operation is still taking place. If cancer is found at the nerve-adjacent edge, your surgeon can remove additional tissue from that side during the same procedure.
Without NeuroSAFE, this information may only become available after the final pathology report is completed. By that stage, your surgery has already finished, and any further decisions may need to be discussed later. Real-time feedback allows your surgeon to respond immediately when needed.
This approach may help improve margin management and reduce uncertainty during surgery. It also means that nerve preservation can continue only when your surgeon has information suggesting it remains a safe option for your cancer.
What Does NeuroSAFE Mean for Surgical Margins?
A positive surgical margin means that cancer cells are found at the edge of the tissue removed during surgery. If you have a positive margin after prostatectomy, it does not automatically mean that your cancer will return. However, it may mean you need closer PSA monitoring and, in some cases, further treatment discussions.
A systematic review and meta-analysis found that NeuroSAFE was associated with increased nerve-sparing and a lower risk of positive surgical margins across the available studies. The review also reported similar biochemical recurrence outcomes compared with standard approaches. For you, this suggests that NeuroSAFE may help support both functional preservation and cancer management.
However, these findings should be interpreted carefully. Your outcome depends on several factors, including your cancer characteristics, surgical expertise, pathology support, and whether you are an appropriate candidate for the technique. NeuroSAFE is a valuable tool, but it is not a guarantee of a specific result.
Better Intraoperative Decision-Making
NeuroSAFE can improve decision-making during your prostate cancer surgery by providing information that would normally only be available after the operation. This allows your surgeon to make decisions based on real-time pathology findings rather than relying only on pre-operative estimates.
This can be particularly useful if your cancer is close to one side of the prostate. Your surgeon may be able to preserve nerves on one side where it is safe while removing additional tissue on the other side where cancer risk is higher. This allows a more tailored surgical approach.
For you, the advantage is that your operation can be adjusted according to the information available during the procedure. NeuroSAFE does not remove the need for careful planning, but it adds another layer of guidance when the decision is complex.
Useful When the Surgical Plan Is Uncertain
Some men have clear findings before prostate cancer surgery. If you are in this group, your cancer may be far enough from the nerves for nerve-sparing to be considered safe, or it may be too close for nerve preservation to be appropriate.
However, some men fall into a grey area where it is difficult to know how much nerve tissue can safely be preserved. This is where NeuroSAFE may provide the greatest value. It gives your surgeon additional information at the exact point where the decision needs to be made.
The technique helps answer a specific question during your operation: is the margin beside the nerve bundle clear of cancer? The result can then guide whether your surgeon continues nerve preservation or removes additional tissue to improve cancer control.
Side-Specific Safety
Prostate cancer does not always affect both sides of the prostate in the same way. If you are having surgery, one side may have a tumour that is closer to a nerve bundle, while the other side may be more suitable for nerve preservation.
NeuroSAFE allows your surgeon to assess the right and left sides separately during the operation. This can support a more personalised approach, such as preserving one nerve bundle while removing more tissue on the other side when needed.
This side-specific approach is an important advantage because your cancer pattern may not be the same on both sides. Instead of treating both sides identically, your surgeon can make decisions based on the findings from each individual side.
It Supports Robotic Surgical Precision
Robotic prostatectomy allows your surgeon to use a magnified three-dimensional view and highly precise instruments during the operation. This can be particularly helpful when working around delicate structures close to the prostate, including the nerve bundles involved in erectile function.
NeuroSAFE adds real-time pathology information to this surgical precision. While the robotic system helps your surgeon carefully remove the prostate, NeuroSAFE provides feedback on whether tissue near the nerves can safely be preserved. This additional information can support more personalised decisions during surgery.
When used in suitable patients, this combination can offer important advantages. It brings together advanced surgical techniques, careful treatment planning, and immediate pathology assessment to help balance cancer control with the possibility of preserving function.
Potential Benefit for Bilateral Nerve-Sparing
Bilateral nerve-sparing means preserving the nerve bundles on both sides of the prostate during surgery. When it is considered safe, this approach may offer the best chance of recovering erectile function after treatment. If you are concerned about life after surgery, preserving both nerve bundles may be an important part of your treatment discussion.
NeuroSAFE may help your surgeon consider bilateral nerve-sparing in cases where a more cautious approach might previously have been chosen. The randomised NeuroSAFE trial found that erectile function outcomes improved in patients who would not otherwise have been offered bilateral nerve-sparing surgery.
However, bilateral nerve-sparing is not suitable for everyone. If cancer is close to one or both nerve bundles, your surgeon may need to remove additional tissue to achieve better cancer control. The priority is always to remove the cancer safely while preserving function whenever possible.
Potential Benefit for Unilateral Nerve-Sparing
Unilateral nerve-sparing means preserving the nerve bundle on one side of the prostate while removing more tissue on the other side. This approach may be considered when the cancer is mainly located close to one side of the prostate. If you are suitable for this technique, preserving one nerve bundle may still support better functional recovery.
NeuroSAFE can help your surgeon check whether the side chosen for nerve preservation is clear of cancer. If the margin is free from cancer cells, the surgeon may be able to continue with the planned nerve-sparing approach. This provides additional confidence during an important stage of your operation.
Even preserving one nerve bundle may offer benefits compared with removing both sides. However, your recovery will depend on several factors, including your function before surgery and the specific details of your cancer and treatment. Your surgeon can help you understand what outcome may be realistic in your situation.
It May Improve Short-Term Urinary Outcomes
NeuroSAFE is mainly discussed for its role in nerve-sparing surgery and erectile function recovery. However, some research has also suggested that it may support better short-term urinary continence after prostate surgery. If you are planning treatment, these possible benefits may be worth discussing with your surgeon.
The reason for improved continence outcomes is not fully clear. Recovery depends on factors such as your anatomy, surgical technique, bladder function, pelvic floor strength, age, and healing process. This means the results can vary between different patients.
You should not choose NeuroSAFE only because of a possible continence benefit. Its main purpose is to help your surgeon assess margins and make safer nerve-sparing decisions during surgery. Your surgeon can explain whether it may provide any additional benefit in your individual case.
Clinical Tip
Erectile-function and urinary-continence recovery require different forms of postoperative support.
Sexual rehabilitation may include PDE5 inhibitor tablets, vacuum erection devices, penile injections or other treatments depending on your health and response. These options may support rehabilitation, but they cannot guarantee recovery of spontaneous erections.
Pelvic-floor muscle exercises are primarily intended to support urinary continence. Correct technique is important, and some men benefit from assessment by a pelvic-health physiotherapist or specialist continence service.
Ask your surgical team when each part of rehabilitation should begin and what outcomes are realistic based on your age, health, erectile function before surgery and degree of nerve preservation.
It Encourages Team-Based Care
NeuroSAFE is not a technique carried out by your surgeon alone. It requires close teamwork between the surgical team, pathology specialists, anaesthetic team, theatre staff, and postoperative care team. This coordinated approach helps ensure that each stage of the process is completed effectively.
The pathologist needs to examine tissue quickly while your operation is still underway. Your surgeon then uses this information to make decisions about nerve preservation and additional tissue removal if needed. This requires good communication between everyone involved.
This team-based approach can help improve the overall quality of care you receive. NeuroSAFE is usually most effective in centres with the necessary experience, trained specialists, and systems in place to deliver the technique safely.
It May Be Especially Helpful in Specialist Centres
NeuroSAFE requires a well-organised workflow to work effectively. The tissue must be carefully prepared, transported, frozen, examined, and reported while your operation is still taking place. Each step needs to be completed accurately and efficiently.
Centres with experience in NeuroSAFE are more likely to have the systems and specialist teams needed to deliver the technique successfully. This includes both surgical expertise and pathology experience. If you are considering this approach, it is reasonable to ask about your centre’s experience with NeuroSAFE.
Understanding how often the technique is used and how positive frozen-section results are managed can help you make an informed decision. The experience of the entire team matters, not just the surgical procedure itself.
Better Patient Counselling Before Surgery
One benefit of NeuroSAFE is that it encourages more detailed discussions before your operation. Your surgeon should explain cancer control, nerve preservation, margin risks, and realistic recovery expectations so you understand the possible outcomes before deciding on treatment.
- Balancing Priorities: Surgery involves weighing the benefits of preserving function against safely removing the cancer.
- Understanding Intraoperative Decisions: You should know what may happen if NeuroSAFE detects a positive margin during the operation.
- Informed Consent: Clear information about the benefits, limitations, and potential outcomes helps you make an informed decision.
- Feeling Prepared: Good counselling can help you feel better prepared and understand the possible outcomes.
Overall, NeuroSAFE supports thorough patient discussions, helping you understand your options and what to expect from your prostate cancer surgery.
UK Guideline Note
NICE NG131 does not make a specific recommendation that NeuroSAFE should be used during radical prostatectomy. It supports balanced treatment discussions and recommends access to specialist services for erectile dysfunction and urinary incontinence after radical prostate cancer treatment.
The European Association of Urology recommends offering nerve-sparing surgery when there is a low risk of extracapsular disease on the relevant side. Its current guidance discusses NeuroSAFE as an intraoperative resource that may help surgeons balance functional preservation with surgical-margin assessment.
NeuroSAFE complements MRI, biopsy results, PSA assessment and surgical planning. It does not replace them or the final pathology examination.
It Can Support More Transparent Decision-Making
NeuroSAFE can make the nerve-sparing decision easier for your surgeon to explain. Instead of simply discussing whether nerves were preserved or removed, your surgeon can explain how the intraoperative margin assessment influenced the decision. This can help you better understand what happened during your operation.
If your nerves were preserved, you can have a clearer understanding of why this was considered safe. If additional tissue was removed, you can understand that this decision was made to improve cancer control.
This transparency can also be helpful after surgery. It allows you and your surgeon to have more meaningful discussions about recovery, expected outcomes, and any concerns you may have during follow-up.
It Does Not Replace Cancer Safety
A major benefit of NeuroSAFE is that it helps support nerve preservation while keeping cancer removal as the main priority. The aim is to balance both goals, protecting function where possible while continuing to prioritise appropriate cancer clearance.
If the frozen-section analysis shows that cancer reaches the surgical edge, your surgeon can remove additional tissue from that area. Although this may affect nerve preservation, it is an important safety measure to improve cancer control.
Preserving function is valuable, but it should never come before effective cancer treatment. NeuroSAFE helps your surgical team make informed decisions while keeping oncologically appropriate cancer removal at the centre of the procedure.
It Does Not Replace Final Pathology
NeuroSAFE provides rapid information during your operation, but it does not replace the final pathology report. The final report gives a more detailed assessment of the entire prostate and provides important information about the cancer.
Your final pathology results may include details such as tumour grade, cancer stage, margin status, prostate weight, and other findings that help guide your follow-up care. After surgery, regular PSA monitoring remains an important part of your ongoing care.
NeuroSAFE should be viewed as a tool that supports decisions during the operation. It helps your surgeon make real-time choices, while the final pathology report provides the information needed for your longer-term treatment planning and monitoring.
It May Help Selected Higher-Complexity Cases
Some prostate cancer cases can be more challenging, especially when the tumour is close to the edge of the prostate or imaging results are uncertain. If you are in this situation, your surgeon may need to carefully balance nerve preservation with the need to remove the cancer safely.
NeuroSAFE may be helpful in selected cases because it provides additional information during the operation. This can help your surgeon decide whether the planned nerve-sparing approach is still appropriate based on the margin assessment.
However, NeuroSAFE is not suitable or necessary for every complex case. If your surgeon already knows that wider tissue removal is needed, the technique may not change the safest treatment approach. The decision will depend on your individual cancer features and surgical plan.
What Are the Limits of the Benefits?
NeuroSAFE can provide valuable information during surgery, but it cannot guarantee erectile recovery, urinary continence, clear margins, or prevent cancer recurrence. Your recovery and long-term outcomes will still depend on factors such as your anatomy, healing process, and the characteristics of your cancer.
Research on NeuroSAFE has shown promising results, particularly for nerve-sparing and erectile function outcomes. However, studies differ in their design, patient groups, and methods, so the results need to be interpreted carefully. More research continues to help define where the technique offers the greatest benefit.
If you are considering NeuroSAFE, it is important to have a balanced discussion with your surgeon. The technique is a valuable tool that supports decision-making, but it is not a guaranteed solution for every aspect of prostate cancer treatment.
Who Is Most Likely to Benefit?
You may be more likely to benefit from NeuroSAFE if you have localised prostate cancer where nerve-sparing is possible but the decision is not straightforward. It may be particularly helpful if you have good erectile function before surgery and preserving this function is an important goal for you.
You may be less likely to benefit if the cancer is clearly close to both nerve bundles or if preserving the nerves could affect safe cancer removal. In these situations, your surgeon may recommend removing more tissue to achieve better cancer control.
The decision about NeuroSAFE needs to be personalised to your situation. Your MRI results, biopsy findings, PSA level, cancer grade, tumour location, overall health, and recovery goals will all help guide the right approach for you.
Choosing NeuroSAFE Care
If you are considering specialist NeuroSAFE prostate surgery in London, your consultation should include a clear discussion about whether you are suitable for nerve-sparing. You should understand what NeuroSAFE can realistically add to your operation and how it may affect your treatment plan.
It is important to ask whether the technique is likely to be used on both sides of your prostate or only one side. You should also understand what would happen if cancer is found at the margin during frozen-section analysis and how your surgeon would respond.
Choosing NeuroSAFE is not simply about selecting the most advanced-sounding technique. The right approach depends on your cancer features, anatomy, recovery goals, and the experience of your surgical team. A personalised plan can help you make a decision that is right for your situation.
Myth vs Fact
| Myth | Fact |
| NeuroSAFE guarantees erections. | No. It improves opportunities for nerve preservation but cannot guarantee recovery. |
| NeuroSAFE prioritises nerve preservation over cancer removal. | Cancer control always comes first. |
| Every patient needs NeuroSAFE. | It is most useful in selected patients. |
| Frozen section replaces final pathology. | Final pathology remains the definitive assessment. |
| MRI makes NeuroSAFE unnecessary. | MRI is essential but cannot detect every microscopic cancer focus. |
| A clear NeuroSAFE result proves that all surgical margins are negative. | NeuroSAFE examines designated nerve-adjacent margins. The complete prostate still requires final pathology. |
| NeuroSAFE has proved identical long-term cancer control. | Early findings are broadly reassuring, but longer randomised follow-up is required. |
Key Takeaways
- NeuroSAFE provides frozen-section pathology during surgery.
- It provides additional information to support nerve-sparing decisions.
- NeuroSAFE increased bilateral nerve-sparing from 56% to 82% in the phase 3 trial.
- Cancer control always remains the priority.
- Earlier observational studies suggested favourable margin outcomes, but the phase 3 trial found more small positive margins and similar large or multifocal margin rates.
- Recovery still depends on age, health and baseline erectile function.
- NeuroSAFE requires an established surgical and specialist frozen-section pathology workflow.
- Final pathology remains essential after surgery.
- The randomised trial demonstrated improved 12-month erectile-function scores, but long-term oncological follow-up remains necessary.
FAQs:
1. What is the main benefit of the NeuroSAFE technique?
The main benefit of NeuroSAFE is that it gives your surgeon real-time information about cancer margins during prostate surgery. This can help guide safer nerve preservation decisions while continuing to prioritise cancer control.
2. How does NeuroSAFE help preserve nerves during prostate surgery?
NeuroSAFE examines whether tumour cells reach the designated inked nerve-adjacent surgical margin while the operation is still taking place. If the frozen section is negative, no secondary resection may be required and the initially spared nerve bundle can remain in place.
3. Does NeuroSAFE improve erectile function after prostate surgery?
NeuroSAFE may improve the chances of erectile function recovery by helping preserve nerve tissue when appropriate. However, recovery also depends on factors such as your age, erections before surgery, overall health, and rehabilitation.
4. Does NeuroSAFE reduce the risk of cancer being left behind after surgery?
NeuroSAFE can help identify cancer cells at the surgical margin during the operation, allowing additional tissue removal if needed. However, it does not replace final pathology testing or guarantee that cancer will not return.
5. Is NeuroSAFE suitable for every man having prostate cancer surgery?
NeuroSAFE is not required or suitable for every patient. Your surgeon will consider factors such as your MRI findings, cancer location, tumour grade, and whether nerve-sparing is a safe option for you.
6. Can NeuroSAFE help avoid unnecessary nerve removal?
NeuroSAFE may help reduce unnecessary removal of nerve tissue by providing additional information during surgery. This allows your surgeon to preserve nerves when the frozen-section result and the wider oncological assessment support leaving the initially preserved bundle in place.
7. Does NeuroSAFE replace MRI scans and biopsy results?
No, NeuroSAFE does not replace pre-operative tests such as MRI scans or biopsies. Instead, it adds another layer of information that helps your surgeon make decisions during the operation.
8. Can NeuroSAFE improve urinary continence after prostate surgery?
The phase 3 trial found better urinary continence questionnaire scores at three months after NeuroSAFE-guided surgery. However, the difference was no longer statistically significant at six months. NeuroSAFE should therefore not be presented as providing a proven long-term continence advantage.
9. What happens if NeuroSAFE finds cancer at the nerve-adjacent margin?
If tumour cells are identified at the designated inked nerve-adjacent margin, your surgeon may perform a secondary resection during the same operation. This is intended to address the positive margin but may reduce nerve preservation on that side.
10. What should be considered before choosing NeuroSAFE surgery?
You should consider your cancer characteristics, treatment goals, expected outcomes, and the experience of your surgical team. A specialist discussion can help you understand whether NeuroSAFE is likely to offer meaningful benefits in your individual case.
Final Thoughts: Understanding the Value of NeuroSAFE in Prostate Cancer Surgery
NeuroSAFE offers a more personalised approach to prostate cancer surgery by helping your surgeon make better-informed decisions about nerve preservation during the operation. By providing real-time information about the tissue close to the nerve bundles, it allows your surgical team to preserve nerves where it is considered safe while responding immediately if cancer is detected near the margin. This can help create a better balance between effective cancer removal and protecting important quality-of-life outcomes, including urinary control and erectile function recovery. The technique is especially valuable when the decision about nerve-sparing is uncertain and requires careful judgement.
Although NeuroSAFE is an important surgical innovation, successful outcomes still depend on careful patient selection, experienced surgeons, specialist pathology support and structured postoperative rehabilitation. If you are considering treatment options, understanding whether you may benefit from NeuroSAFE prostate surgery in London can help you have a more informed discussion with your specialist. The technique is not a guarantee of outcomes, but for suitable patients, it can provide valuable guidance when nerve preservation decisions are complex.
References:
- National Institute for Health and Care Excellence (NICE) (2019, last updated 2021; reviewed 2025) Prostate cancer: diagnosis and management. NICE guideline NG131. Available at: nice.org.uk/guidance/ng131
- NHS (no date) Treatment for prostate cancer. Available at: nhs.uk/conditions/prostate-cancer/treatment
- Prostate Cancer UK (no date) Surgery: radical prostatectomy. Available at: prostatecanceruk.org/prostate-information-and-support/treatments/surgery
- Cancer Research UK (no date) Problems after prostate cancer surgery. Available at: cancerresearchuk.org/about-cancer/…/problems-after-prostate-surgery
- European Association of Urology (EAU) (2026) EAU guidelines on prostate cancer: treatment. Available at: uroweb.org/guidelines/prostate-cancer/chapter/treatment
- Dinneen, E. et al. (2025) ‘Effect of NeuroSAFE-guided robot-assisted radical prostatectomy versus standard robot-assisted radical prostatectomy on erectile function and urinary continence in patients with localised prostate cancer: the NeuroSAFE PROOF phase 3 trial’, The Lancet Oncology, 26(4), pp.447–458. Available at: pubmed.ncbi.nlm.nih.gov/40147459
- Kroon, L.J. et al. (2025) ‘Neurovascular structure-adjacent frozen-section examination during radical prostatectomy: a systematic review and meta-analysis’, European Urology Oncology, 8(5), pp.1365–1374. Available at: pubmed.ncbi.nlm.nih.gov/39730246
- van der Slot, M.A. et al. (2022) ‘NeuroSAFE in radical prostatectomy increases the rate of nerve-sparing surgery without affecting oncological outcome’, BJU International, 130(5), pp.628–636. Available at: pubmed.ncbi.nlm.nih.gov/35536200
- Noël, J. et al. (2022) ‘NeuroSAFE robot-assisted radical prostatectomy: outcomes from 500 consecutive UK cases’, Journal of Robotic Surgery, 16, pp.951–956. Available at: pubmed.ncbi.nlm.nih.gov/34716876