As many as one-fourth of the men diagnosed with prostate cancer could be helped by a new procedure to preserve sexual function after cancer surgery.
University of Washington physicians last month performed the first two of the operations in the Northwest on two men. Nerves from their legs were used to replace nerves damaged when their cancerous prostates were removed.
When the surgery becomes widespread, it could preserve sexual functioning in about 100,000 men a year, said Dr. Paul Lange, director of the UW department of urology.
Lange performed the surgery on one man in his 50s and another in his early 60s. He was assisted by urologist Bill Ellis and neurosurgeon Michel Kliot, both UW physicians.
A half-dozen other medical centers nationwide are performing the nerve-preserving surgery, which was pioneered about three years ago at Baylor University in Houston.
Operations to remove the prostate are performed when cancer has spread beyond the prostate, a gland that releases a substance that makes semen into a liquid. To get all the cancer, surgeons also remove 1 to 2 centimeters of tissue surrounding the gland, and that may damage nerves that stimulate erections.
Nearly 60 percent of men whose prostates are removed become impotent and more than 8 percent lose bladder control, scientists at the Fred Hutchinson Cancer Research Center reported last month. The report was based on the most extensive survey ever done of such patients.
"In this particular cancer, quality of life is a major issue in that treatment involves impotence and incontinence," Lange said. "Prostate cancer does not grow so fast that people are worried only about dying . . . This is often the first physical (threat) that has occurred to them, a sign that they are losing some power, and it hits hard."
When performing prostatectomies, or prostate removals, surgeons can cut around existing nerves close to the gland and preserve full sexual function. At some centers, including the UW, they do that up to 70 percent of the time. But sometimes the nerve is cut or too much damage is done to preserve sexual function.
The nerve transplant, or graft, is performed at the same time as the prostatectomy when it is apparent erections will not be possible because of nerve damage. Lange said the surgery can't be done later because of scar tissue.
During the procedure, the surgeon finds the ends of the damaged microscopic nerves with an electric probe. Then a segment of the sural nerve, running from the ankle to the calf, is removed and sewn or surgically glued into the gap.
"What the nerve graft does is provide a conduit through which thousands of nerve fibers can grow," said Lange. The nerves also excrete growth factors, which stimulate the nerve to grow through the conduits.
In the operations on the two men last month, double strands of the sural nerve were used to bridge the nerve gaps. It will take about six months for the nerves to grow, healing to occur and functioning to be restored, Lange said. The surgery may leave a small numb area in the men's ankles, where the nerves were removed, he said.
Certain types of nerve grafts are common, as when hands, legs or arms are reattached.