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