Prostate cancer surgery: Is nerve-sparing safe?

Prostate cancer will be diagnosed in an American man once every three minutes each year. Every one of these 230,000 men will have to decide which treatment is best for him. It's an important decision but a hard one — not because of dire implications, but because there are so many good options for managing tumors confined to the prostate itself. Surgery, external beam radiotherapy, and radioactive "seed" implants (brachytherapy) all have their advantages, and newer treatments such as cryotherapy, which destroys prostate tissue by freezing it, are entering the picture. To complicate matters further, combinations of hormonal therapy with radiation or, possibly, surgery are also very promising. And for older men with low-grade tumors, watchful waiting can also be an option.

Randomized clinical trials are needed to decide which treatment is best for which patient. This research is complex and slow, however. In the meantime patients should consult with several physicians from different fields, such as urological surgery, radiation oncology, and medical oncology, in addition to their own doctors.

Many patients decide to "get it all out" with an operation that removes the entire prostate. Indeed, a radical prostatectomy can be an excellent choice, particularly for younger men in good general health with moderate to high-grade tumors. But younger men are particularly distressed by the prospect of impotence, a nearly universal occurrence following the standard operation. That's why Dr. Patrick Walsh developed the nerve-sparing radical prostatectomy in the 1980s. While it has enabled many men to retain erectile function after surgery, some doctors have worried that the less extensive operation may leave cancer cells behind. It's a dilemma for patients, but a study from the University of Miami should help ease the worry.

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