| Treatment for prostate cancer is one of the most | | | | You are not only removing a tumour; you must do |
| rapidly developing areas in medicine, providing men | | | | as little damage to the nerves which control erections |
| with a wide and sometimes confusing range of | | | | and the muscle which holds and releases urine. |
| treatment options. | | | | Having undertaken more than 800 prostatectomies, I |
| While our scientific understanding of the disease is | | | | know the benefits this experience brings to my work |
| marching forward, the culture of the doctor patient | | | | in terms of outcomes for patients. |
| relationship in the UK is changing more slowly. | | | | I was one of the first surgeons in the UK to carry |
| Some patients remain reluctant to ask their doctor | | | | out keyhole prostatectomy in 2003; a far less |
| many questions. | | | | invasive procedure with reduced bleeding and risk of |
| Others may grill their doctor a little more, but steer | | | | complication. I have now completed more than 400 |
| clear of the question I see as the most important of | | | | keyhole prostatectomies. |
| all: how many of these procedures have you carried | | | | I have also been able to develop my nerve-sparring |
| out? | | | | techniques, reducing the margins between the |
| In America for example, patients are well practiced in | | | | removal of the tumour and the erectile nerves. |
| researching treatment options then asking doctors | | | | This kind of precision work is dependent upon the |
| about their experience and outcomes. Much of this | | | | surgeon continuously using and developing his or her |
| data is widely available on the internet. | | | | skills by undertaking a large and regular caseload. |
| However in the UK, this approach remains rather | | | | To set this into a broader context, the recent |
| alien. I do see a growing number of patients who | | | | publication of cardiac surgery statistics is a major |
| have found my clinic through their own research, | | | | development for the public scrutiny of surgery. |
| rather than a GP or consultant referral. | | | | However, this is only one, relatively small field, where |
| But patients rarely ask how many procedures I have | | | | poor performance of surgeons can, in some cases, |
| carried out. This is possibly due to a sense of | | | | contribute to death. |
| respect; a perception that it may suggest a lack of | | | | In prostate surgery post-operative mortality is almost |
| trust. | | | | non-existent. But there are very significant |
| Yet it is so important. Your ability to perform a | | | | differences for patients in terms of the quality of life |
| procedure safely, effectively, with the optimal | | | | they can enjoy after surgery. |
| outcome for your patient is based, to a very | | | | You are dependent upon the skills of your surgeon |
| significant extent, upon your experience of that type | | | | to not only remove all the cancer cells, but in doing |
| of surgery. | | | | so, cause as little damage as possible to the adjacent |
| The number of procedures undertaken by individual | | | | erectile nerves and the bladder. |
| surgeons varies dramatically. A surgeon may be | | | | You are most certainly within your rights to ask your |
| trained and skilled to perform a particular operation. | | | | surgeon how many procedures he or she has |
| That does not mean that he or she is the best | | | | completed and whether your operation can be |
| surgeon for you. | | | | undertaken as keyhole and nerve-sparing surgery. |
| Prostate surgery is a field in which experience can | | | | I welcome all questions from my patients and their |
| make a critical difference to outcomes. The removal | | | | families as this is as critical to making an informed |
| of a prostate (prostatectomy) is technically very | | | | choice about the right treatment option for them. |
| challenging because there is a functional aspect to it. | | | | |