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