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Using frozen fraction (neurosave) during surgery to determine if nerves should be removed?

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User
Posted 04 Aug 2021 at 17:10

A high standing surgeon at a top German clinic informed me that during the DaVinci surgery they do a frozen fraction of nerves (neurosave If I'm not mistaken) and they quickly check them during the surgery to see if there are mets. Then they decide to remove the nerves or do a nerve sparing operation.

I might have made a mistake describing it, but how common is this practice and where can I learn more about it? I didn't see anything said about it in the .pdf sheets from Workshop / Toolbox.

Has anyone heard about it?

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery in 2021. PSA rising after surgery. What to do next?

User
Posted 05 Aug 2021 at 07:45

Neurosafe is a live biopsy of tissues removed during surgery, which are delivered to an adjacent lab for a technician to check if they are cancerous, so the surgeon knows how much to remove and what can safely be left behind.

I know Professor Whocannotbenamedhere offers Neurosafe during his private operations at The London Bridge Hospital (£20,000), and it is clearly a gold standard, but I’m not sure how many NHS hospitals offer it, if any.

Techguy had Neurosafe during his surgery, and he, like you, looked into all possibilities before opting for prostatectomy and a surgeon to carry it out.

Check out his previous posts, where he talks extensively about this.

Cheers, John.

Edited by member 05 Aug 2021 at 07:46  | Reason: Not specified

User
Posted 05 Aug 2021 at 07:51

Hello,

It's called neurosafe. It's the prostate gland itself that is taken out and analysed while the patient is still asleep. If the margins around the removed prostate are clear (ie the cells enveloping the prostate are healthy, not cancerous) then the neurovascular bundles (which are still in your body and were in close contact with the prostate at the said margins) can be retained which increases the chance of potency returning.... orherwise they need to be removed to some degree with consequences on potency... If you go for RP try get neurosafe.

One day at a time...

User
Posted 05 Aug 2021 at 08:16

A number of surgeons do it privately. It's often more difficult to do it in large NHS hospitals. It needs pathology services sitting reading and waiting. In many NHS hospitals, pathology services are not on the main hospital site, having been moved to non-patient sites to make space for more patient services.

The NHS has been running a trial in some hospitals capable of doing the procedure, where each patient is randomly assigned neurosafe or non-neurosafe (single-blinded - they aren't told which), and the patients report on progress afterwards. At some point, the patient is unblinded.

I believe the Lister in Stevenage is a hospital which offers neurosafe on the NHS.

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User
Posted 05 Aug 2021 at 07:45

Neurosafe is a live biopsy of tissues removed during surgery, which are delivered to an adjacent lab for a technician to check if they are cancerous, so the surgeon knows how much to remove and what can safely be left behind.

I know Professor Whocannotbenamedhere offers Neurosafe during his private operations at The London Bridge Hospital (£20,000), and it is clearly a gold standard, but I’m not sure how many NHS hospitals offer it, if any.

Techguy had Neurosafe during his surgery, and he, like you, looked into all possibilities before opting for prostatectomy and a surgeon to carry it out.

Check out his previous posts, where he talks extensively about this.

Cheers, John.

Edited by member 05 Aug 2021 at 07:46  | Reason: Not specified

User
Posted 05 Aug 2021 at 07:51

Hello,

It's called neurosafe. It's the prostate gland itself that is taken out and analysed while the patient is still asleep. If the margins around the removed prostate are clear (ie the cells enveloping the prostate are healthy, not cancerous) then the neurovascular bundles (which are still in your body and were in close contact with the prostate at the said margins) can be retained which increases the chance of potency returning.... orherwise they need to be removed to some degree with consequences on potency... If you go for RP try get neurosafe.

One day at a time...

User
Posted 05 Aug 2021 at 08:16

A number of surgeons do it privately. It's often more difficult to do it in large NHS hospitals. It needs pathology services sitting reading and waiting. In many NHS hospitals, pathology services are not on the main hospital site, having been moved to non-patient sites to make space for more patient services.

The NHS has been running a trial in some hospitals capable of doing the procedure, where each patient is randomly assigned neurosafe or non-neurosafe (single-blinded - they aren't told which), and the patients report on progress afterwards. At some point, the patient is unblinded.

I believe the Lister in Stevenage is a hospital which offers neurosafe on the NHS.

User
Posted 05 Aug 2021 at 08:53
He is still in Estonia - NHS provision is still irrelevant to him.

But please can whoever it was that had recurrence after neurosafe post their response now before we have another 10 threads on the topic.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 05 Aug 2021 at 17:16

Originally Posted by: Online Community Member
He is still in Estonia - NHS provision is still irrelevant to him

Of course I know that the O.P. is in Estonia, but I realise that these pages are read by people world-wide, as well as the UK, which is why I mentioned the NHS.

Cheers, John.

User
Posted 05 Aug 2021 at 20:54
I wasn't reacting to your post Bollinge; I was adding some context to Andy's comment re the NHS trial.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 07 Aug 2021 at 18:04

hi John (Bollinge)

Yes, Neurosafe is a fantastic tool for visibility. Thankfully the prof included it as part of the procedure. I believe NICE are evaluating It for the NHS with a view to potentially making is available in due course.

User
Posted 07 Aug 2021 at 19:00

Hi Interestedin Results

I just had RP with neurosafe 5 weeks ago at the Guys Private Cancer centre at London Bridge with one of the Ninja surgeons there ( same team as TechGuy) and it certainly seems to have worked for me in terms of ED as I am functioning at about 95% of previous potency which I found very surprising. Orgasms are very nice  but dry as Im sure you know.  I am also continent at about 97% with just a few dribbles if I try to squeeze a fart. Whether it makes a difference to long term survival rates Im not sure and as Lyn says there are also recurrences after Neurosafe so its still a lottery I reckon. But if you go for RP, which at your age should probably be a strong candidate you would probably be wise to do it with Neurosafe as well. It cant do any harm I dont think. I certainly dont regret surgery at this point and was advised that because of my age and staging ( multifocal T2bN0M0)  that RP was the best option for me. But who the hell really knows in the end if it will turn out to be the right decision or not. I suggest you consult the best experts in the world and then trust your gut instinct in the end. You have to be happy with the decision you make for you and dont worry too much about what other people say as its your body and your life. Once youve made your decision, and dont take too long to make it ,  you will sleep much easier Im sure. Best of luck

User
Posted 09 Aug 2021 at 15:37
@Interestedinresults

I see from your updated Profile that you have decided to go for RP Surgery within the next three months. I wish you the best of luck with it. Hopefully you feel comfortable with your decision and will get a good result. Best wishes

User
Posted 09 Aug 2021 at 20:07
Have a look at Piers12's thread - he has a biochemical recurrence despite Neurosafe
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

 
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