Nerve-sparing prostatectomy results
“The first priority must be the safe and effective treatment of cancer. We look very carefully at each patient’s Gleason score, staging and PSA before assessing whether an attempt at top quality nerve-sparing surgery is an appropriate option. Non index patients may still be offered an attempt at nerve-sparing but only if it is considered safe to do so.”
Alan Doherty, clinical director
The Birmingham Prostate Clinic
Birmingham Prostate Clinic has established a unique study group, known as index patients, to measure and publish the effectiveness of nerve-sparing prostatectomy.
The nerve-sparing prostatectomy has been introduced in more recent years by a small number of specialist surgeons. It is a procedure for patients with organ confined prostate cancer.
Nerves which control erections run adjacent to the prostate. Traditional prostate surgery was associated with incontinence and erectile dysfunction because removing the prostate involved dividing and damaging these adjacent nerves.
However specialist surgeons, with extensive experience of prostatectomies, are able to safely remove the prostate and minimise damage to nearby nerves. The techniques involved are very complex and only surgeons who regularly carry out a large number of prostatectomies will have the experience and skills to successfully nerve-spare.
Why an index group of patients?
Although a growing number of surgeons offer nerve-sparing surgery, it is difficult for patients to evaluate what is meant by this term or to compare the success rates of different surgeons.
This is because success rates will depend upon the group of patients being measured. Younger patients, with good erectile function before surgery who are motivated to continue with sexual intercourse will inevitably have better outcomes than older patients who may have poorer function and motivation prior to surgery.
Equally, erectile function is measured in different ways. Some surgeons use the term ‘erectile recovery’ and report figures of 90 per cent or more with erectile recovery. However, this term can be misleading because many patients believe it indicates full erectile function. The definition of erectile function is narrower, referring to any degree of penile enlargement, including very small changes which are insufficient for sexual intercourse.
Alan Doherty, clinic director of Birmingham Prostate Clinic: “First of all, we need to have a system for having a clear baseline, or starting point, so there is a clear understanding of the group of patients we are assessing. Secondly, we need precise measures of erectile function which we are transparent and fully understood.”
The index group allows us to do two things:
- Provide you with clear, meaningful results from a large group of patients who have had nerve-sparing surgery
- Enables us to evaluate our results and further refine nerve-sparing techniques in order to achieve best outcomes
Who is an index patient?
There are currently 40 patients in Birmingham Prostate Clinic’s index study. Index patients fulfil the following criteria:
- Early, organ confined prostate cancer allowing for safe nerve-sparing surgery
- Full erectile function prior to prostate surgery
- Motivation to resume sexual intercourse following prostate surgery
Approximately 30 per cent of our patients fulfil the criteria to become an index patient.
