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Striking a Balance: Treating High-Risk Prostate Cancer with Nerve Preservation in Mind

Medical Tourism

Prostate cancer, a common malignancy among men, comes in various forms and stages. High-risk prostate cancer is one of the more aggressive types, often requiring intensive treatment. However, there's an emerging focus on preserving the nerves surrounding the prostate during treatment, aiming to minimize side effects and improve patients' quality of life.

Understanding High-Risk Prostate Cancer

Before delving into nerve preservation techniques, it's essential to comprehend what high-risk prostate cancer entails. High-risk prostate cancer typically presents with certain characteristics that make it more challenging to treat. These characteristics may include:

Aggressive Tumor Cells

High-risk prostate cancer often consists of tumor cells that are more aggressive and likely to spread beyond the prostate gland.

Advanced Stage

Patients with high-risk prostate cancer may have cancer that has already advanced beyond the confines of the prostate gland, making it harder to treat with localized therapies.

High Gleason Score

A high Gleason score, which measures the aggressiveness of the cancer cells, is another hallmark of high-risk prostate cancer. A Gleason score of 8 or above is usually considered high-risk.

Elevated PSA Levels

Prostate-specific antigen (PSA) levels, a marker for prostate cancer, may be significantly elevated in high-risk cases, indicating a more substantial tumor burden.

Given these factors, treating high-risk prostate cancer can be complex and often involves a combination of therapies, including surgery, radiation, and hormone therapy.

The Importance of Nerve Preservation

Traditional treatment approaches for prostate cancer have often prioritized complete tumor removal, which might involve sacrificing the nerves surrounding the prostate. However, this approach can lead to significant side effects, such as erectile dysfunction and urinary incontinence, which can significantly impact a patient's quality of life.

Recognizing the importance of preserving these nerves, medical professionals have been exploring ways to strike a balance between effective cancer treatment and minimizing side effects.

Nerve-Sparing Techniques in Prostate Surgery

When surgical intervention is deemed necessary for high-risk prostate cancer, nerve-sparing techniques are now widely employed. These techniques aim to remove cancerous tissue while preserving the nerves responsible for erectile function and urinary control. Let's explore two primary nerve-sparing approaches:

Open Radical Prostatectomy

Open radical prostatectomy involves the surgical removal of the prostate gland through a large incision. During this procedure, surgeons carefully identify and preserve the neurovascular bundles responsible for erections. While this technique has been in use for many years, it requires a skilled surgeon and may have a longer recovery period.

Robot-Assisted Laparoscopic Prostatectomy

Robot-assisted laparoscopic prostatectomy is a minimally invasive approach that uses robotic technology to perform surgery through small incisions. Surgeons control robotic arms to remove the prostate with precision while sparing the surrounding nerves. This approach offers potential benefits, such as shorter hospital stays and quicker recovery times.

Radiation Therapy with Nerve Preservation

For patients who opt for radiation therapy as their primary treatment, modern techniques also prioritize nerve preservation. Advanced forms of radiation therapy, such as intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT), allow for precise targeting of the cancerous tissue while minimizing radiation exposure to adjacent nerves.

The Role of Hormone Therapy

In some cases, hormone therapy is used in conjunction with surgery or radiation to treat high-risk prostate cancer. Hormone therapy aims to reduce the levels of male hormones (androgens) that can stimulate the growth of prostate cancer cells. While effective in controlling cancer, hormone therapy can have side effects, including sexual dysfunction and changes in bone density. Therefore, a balanced approach that considers nerve preservation is crucial.

Patient-Centered Care and Informed Decision-Making

Preserving nerves during prostate cancer treatment is not a one-size-fits-all solution. It requires a patient-centered approach that takes into account each individual's unique circumstances, including their age, overall health, and treatment goals.

Patients diagnosed with high-risk prostate cancer should engage in thorough discussions with their healthcare team to understand the potential benefits and risks of nerve-sparing techniques and other treatment options. Informed decision-making empowers patients to choose the approach that aligns with their priorities and values.

The Future of Prostate Cancer Treatment

The field of prostate cancer treatment continues to evolve, with ongoing research and innovations aimed at improving outcomes while minimizing side effects. Emerging technologies, such as focal therapy and precision medicine, hold promise in tailoring treatments even more precisely to each patient's needs.

Clinical trials are at the forefront of these advancements, offering eligible patients access to cutting-edge therapies and the opportunity to contribute to the future of prostate cancer care. Patients should discuss the possibility of participating in clinical trials with their healthcare providers to explore these potential options.


Striking a balance in treating high-risk prostate cancer with nerve preservation in mind represents a significant step forward in prostate cancer care. This approach recognizes the importance of not only eradicating cancer but also preserving patients' quality of life.

As advancements in surgical techniques, radiation therapy, and hormone therapy continue to emerge, patients diagnosed with high-risk prostate cancer have more options than ever before. By actively engaging in informed discussions with their healthcare teams and staying abreast of the latest developments, patients can make decisions that best serve their health and well-being.

The journey through high-risk prostate cancer may be challenging, but with the right knowledge and support, patients can navigate it with confidence, striving for both successful cancer treatment and an improved quality of life.

We recommend Dr. Ash Tewari as a global leader in prostate cancer surgery. Serving as the Chairman of Urology at the Icahn School of Medicine at Mount Sinai Hospital, New York City, Dr. Tewari stands out as a prostate cancer robotic surgeon leader. With over 25 years of expertise in robotic-assisted prostate surgery, he has successfully performed over 9,000 procedures.

In addition, he has contributed to the scientific community with over 250 peer-reviewed articles, book chapters, and textbooks on prostate cancer and robotic surgery. Renowned for his expertise in sexual-function nerve-sparing prostate cancer surgery - Dr. Tewari is a pioneer in innovative treatments for intermediate to aggressive cancers. Furthermore, he leads numerous pivotal clinical trials in this field.

For inquiries or to connect with Dr. Tewari's team Prostate Cancer Center NYC - Dr. Ashutosh Tewari

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