Good news! Perhaps more men will be willing to undergo treatment earlier etc.
Approach no. 1: A new type of prostate cancer surgery NeuroSAFE-guided RARP
"A new type of prostate cancer surgery aims to save nerve tissue in the outer layers of the prostate, which increases the chances of men retaining erectile function after the operation. During the procedure — coined NeuroSAFE — samples of the removed prostate are flash frozen and analysed to determine the boundaries of the tumour. If no cancer is found on the surface of the prostate, the outer layers can be left intact. In a phase III trial, fewer men who had a prostatectomy with NeuroSAFE experienced erectile dysfunction a year after the surgery than those who got the standard procedure."
From the abstract:
"Background
Sparing the periprostatic neurovascular bundles during robot-assisted radical prostatectomy (RARP) improves postoperative erectile function and early urinary continence recovery. The NeuroSAFE technique, a standardised frozen section analysis, enables accurate real-time detection of positive surgical margins during nerve-sparing, increasing the likelihood of successful nerve preservation. However, the impact of the technique on patient outcomes remains uncertain. We aimed to assess the effect of NeuroSAFE-guided RARP versus standard RARP on erectile function and urinary continence.
Methods
NeuroSAFE PROOF was a multicentre, patient-blinded, randomised, controlled phase 3 trial done at five National Health Service hospitals in the UK. ...
The primary outcome was erectile function at 12 months, assessed using the IIEF-5 score, in the modified intention-to-treat population, which included all randomly assigned participants who had surgery.
Secondary endpoints were urinary continence scores at 3 and 6 months, evaluated using the International Consultation on Incontinence Questionnaire (ICIQ), and the erectile function domain of the IIEF (IIEF-6) scores at 12 months. ...
Findings
Between Jan 6, 2019, and Dec 6, 2022, 407 patients were recruited, of whom 381 had surgery (190 participants in the NeuroSAFE group and 191 participants in the standard RARP group), and were included in the modified intention-to-treat population. ...
At 12 months, the mean IIEF-5 score was 12·7 (SD 8·0) in the NeuroSAFE group versus 9·7 (7·5) in the standard RARP group (adjusted mean difference 3·18 [95% CI 1·62 to 4·75]; p<0·0001).
At 3 months, the ICIQ score was significantly lower in the NeuroSAFE group than the standard RARP group (adjusted mean difference –1·41 [95% CI –2·42 to –0·41]; p=0·006).
At 6 months, no significant difference in ICIQ score was observed between groups (adjusted mean difference –0·37 [95% CI –1·35 to 0·62]; p=0·46).
At 12 months, the mean IIEF-6 score was higher in the NeuroSAFE group than in the standard RARP group (15·3 [SD 9·7] vs 11·5 [SD 9·0]; adjusted mean difference 3·92 [95% CI 2·01 to 5·83]; p<0·0001). ...
Interpretation
The use of NeuroSAFE to guide nerve-sparing during RARP improves patient-reported IIEF-5 scores at 12 months and short-term urinary continence. The erectile function benefit is enhanced in patients who would not otherwise have undergone bilateral nerve-sparing by standard practice. ..."
Approach no. 2: Image-Guided Prostate Cancer Treatment OPTIMUM
"A less expensive, more accessible, and comfortable alternative exists for those facing a prostate cancer biopsy, according to findings from a new clinical trial ...
Authors say OPTIMUM, the first head-to-head trial comparing micro-ultrasound-guided versus MRI-guided biopsies, signifies a breakthrough in image-guided treatment. ..."
From the key points and abstract:
"Key Points
- Question
Is high-resolution microultrasonography-guided biopsy noninferior to magnetic resonance imaging (MRI) fusion-guided biopsy in the detection of clinically significant prostate cancer? - Findings
In this randomized clinical trial that included 678 participants, microultrasonography-guided biopsy was noninferior to MRI fusion-guided biopsy for detection of Gleason Grade Group 2 or higher prostate cancer (difference, 3.52% [95% CI, −3.95% to 10.92%]; noninferiority P < .001). - Meaning
Microultrasonography-guided biopsy was noninferior to MRI fusion-guided biopsy and may provide an alternative to MRI for image-guided prostate biopsy.
Abstract
...
Conclusions and Relevance
The use of microultrasonography-guided biopsy was noninferior to MRI/conventional ultrasonography fusion-guided biopsy for the detection of Gleason Grade Group 2 or higher prostate cancer in biopsy-naive men. Microultrasonography may provide an alternative to MRI for image-guided prostate biopsy."
The use of microultrasonography-guided biopsy was noninferior to MRI/conventional ultrasonography fusion-guided biopsy for the detection of Gleason Grade Group 2 or higher prostate cancer in biopsy-naive men. Microultrasonography may provide an alternative to MRI for image-guided prostate biopsy."
Figure 1 Trial profile (approach no. 1)
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