MORE THAN HALF OF MEN who undergo prostate cancer surgery experience severe erectile dysfunction, but a study published March 24, 2025, in Lancet Oncology suggests a real-time tumor analysis technique used during surgery may help improve outcomes. 

Treatment for localized prostate cancer often involves robot-assisted surgery to remove the prostate and surrounding tissue. Surgeons must remove enough tissue to clear the cancer, but that sometimes damages nearby nerve bundles that are vital for bladder control and sexual function. This procedure often successfully eliminates the cancer but can cause incontinence and erectile dysfunction. “We can cure the cancer. We now need to decrease the toxicity of surgery,” says Greg Shaw, a urological surgeon at University College London Hospitals in the U.K. 

Currently, surgeons use MRI and tissue biopsy to map the cancer before surgery, but these methods do not offer the fine detail needed for precise cancer control, according to Shaw. With a tissue analysis technique called Neurovascular Structure Adjacent Frozen Section Examination (NeuroSAFE), surgeons remove slices of prostate tissue near the nerve bundles during surgery. The removed tissue is frozen and examined by a pathologist, all within about an hour. If the pathologist does not find any cancer cells in the tissue, surgeons can immediately adjust their plan and perform what is called a nerve-sparing prostatectomy, which leaves the nerve bundles intact. 

In a phase III clinical trial, 381 men with localized prostate cancer who had no prior history of erectile dysfunction had surgery to remove their prostate and surrounding tissue. Half the participants underwent the standard procedure without tissue analysis, and half had surgery guided by the NeuroSAFE technique. Researchers found 56% of the men who had the standard surgery without NeuroSAFE reported severe erectile dysfunction—meaning they were consistently unable to have sexual intercourse—after one year, compared with 38% in the NeuroSAFE group. Men who had surgery with NeuroSAFE also had better urinary control at three months. 

Future research will need to evaluate NeuroSAFE’s long-term effects and optimal use, says Shaw, who led the study. In addition, NeuroSAFE requires pathologists in a nearby lab, which prevents many hospitals from using it. Other variations of NeuroSAFE are under development, including one that would scan the prostate surface and produce images surgeons can share with off-site pathologists.