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Prostate Cancer: New Help for Tough Choices

Better Surgery

A major problem with prostate surgery is that the nerves that control both erectile function and urination run through bundles on either side of the prostate gland. Unfortunately, prostate tumors often appear on the side of the gland right next to these nerve bundles -- and sometimes they push right up against them.

New nerve-sparing surgery has greatly reduced the number of men who lose the ability to have erections and to control urination. But when the tumor sits in a bad place, a surgeon often will have to cut the nerve to make sure the entire tumor is removed.

"Patients with nerve-sparing surgery do best in terms of recovering their sexual potency," Disa says. "If you damage the nerves but don't destroy them, you have a 75% chance of recovery. If one of the nerves is destroyed, this drops to about 50% -- and if both nerves are destroyed, there is no chance of recovering potency."

But now, help is on the way. Disa and colleagues have pioneered a new technique in which a nerve taken from just below the ankle can be used to replace one or both of the nerves destroyed by prostate surgery.

"If you graft patients with one nerve removed, up to 75% without prior radiation or chemotherapy are regaining sexual function," Disa says. "With prior therapy, it seems to be about 50%, equivalent to what you would see if nerve-sparing therapy were possible for patients in this group. With bilateral nerve construction, after 24 months, 33% are recovering erections good enough for intercourse -- and another 25% have improvement with Viagra. This is the group that would have had no erectile function without the grafts."

Scardino warns that the new technique is not free of risk.

"There are potential downsides," he says. "We have shown that the operative time is longer, costs are greater, blood loss can be greater, so there may be a need for transfusions. And there may be problems at the donor site [the ankle], which, though uncommon, are not unheard of. Before it can be considered for everyone, it needs to be proven in a [scientific] trial."



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