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Study results on nerve sparing technique in RP

petabyte profile image
10 Replies

I just saw this.

A more precise form of prostate cancer surgery nearly doubles the chances of men retaining erectile function afterwards compared with standard surgery, according to the first comprehensive trial of the procedure.

theguardian.com/society/202...

Link to the study results in the Lancet

thelancet.com/journals/lano...

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petabyte profile image
petabyte
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10 Replies
Tall_Allen profile image
Tall_Allen

This isn't new. Taking frozen sections with a pathologist standing by has been done by some surgeons for at least 10 years. Retzius-sparing is the trend currently. I hope you talked to a radiation oncologist as well.

Don717 profile image
Don717 in reply toTall_Allen

Don't panic TA...OP already had RT/Treatment.

Tall_Allen profile image
Tall_Allen

ChatGPT isn't a good way to come to a decision - talking to experts is. Will you go through the AI link and figure out what is wrong and what is right?

MarkS profile image
MarkS

The latest RT rates of full erectile function with IMRT are 70% after 2 years and 66% after 5 years: academic.oup.com/jsm/articl...

This compares with 23% who had standard surgery and 39% who had neurosafe. So if you want to retain erectile function, the answer is pretty obvious.

davcarv profile image
davcarv in reply toMarkS

I was of the understanding that the rates of ED overtime are pretty much equal for either. The difference being ed occurs immediately for RP and eventually for RT.

But at the end of the day similar reaults.

Am I mistaken ?

MarkS profile image
MarkS in reply todavcarv

They used to be similar, but over the last ten years, new RT methods such as IMRT and VMAT which are accurate to 1 mm precision have changed the game.

davcarv profile image
davcarv in reply toMarkS

So unless i’m wrong I believe the treatment standard continues to be whole gland.

Seems to me that all structures would be impacted especially the nerve bundles.

I would love it if medical establishment was doing focal RO if they are I’ve not seen it.

Teufelshunde profile image
Teufelshunde

Rates vary greatly by doctor. Ask your doctor what his rates are. If he does not know them precisely when asked, run! I remember my wife and I asked the doc at U Chicago that my urologist recommended (over his own practice). He knew them each (erectile function and urinary issues) for two different time periods. Never had either issue. He also put me on daily low dose ED drug and still on 5 years later. And of course, the UC physical therapist BEFORE surgery for kegels, etc. To me the general stats are meaningless.

bean1008 profile image
bean1008

What I would love to hear about is a way to restore erectile function! Afraid that ship sailed with me after my RP. :-(

Flatman profile image
Flatman

Tall Allen is correct to say the technique isn’t new. However, there’s a very important additional background detail to this story.

I’m in The UK, and was a participant in this ‘Neurosafe’ study. It was explained to me at sign-up that one of its key aims was to spread the message about the technique and provide the robust clinical evidence needed to encourage the UK’s National Health Service (NHS) to consider routinely funding it, which of course costs more to deliver than ‘standard’ RARP.

Without robust evidence and cost benefit analysis, there are many emerging medical treatments, including this one, that our NHS simply won’t pay for, despite the fact that we are already paying for our healthcare through our taxation system.

Value for money for the taxpayer is considered key, and there’s always intense competition for resources, sometimes leading to postcode lotteries etc, where local or national policies differ.

Only the relatively well off can afford to fund private health insurance and/or treatment, and thereby access the latest support that hasn’t been through the robust review process needed to place it on The NHS’s shopping list.

Therefore, the study is potentially an extremely important step towards equal access to better healthcare for many men in the UK, and perhaps it will be so in some other countries too. Let’s hope it makes a big difference.

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