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