Laparoscopic prostate surgery results
Operating times
Continence
Ultrasensitive PSA nadir
Erections
Margins
We are committed to publishing our laparoscopic prostate surgery results, in line with the latest advise from the UK Prostate Cancer Advisory Group, which urges patients to make choices based on the surgeon’s results and experience, rather than a particular technique.
The Birmingham Prostate Clinic is committed to making our results data available and accessible to the public.
We publish a wide range of measurements, based on information which is most clinically relevant and important to patients.
This data has recently been used in a major study to assess how surgeon’s results improve as they undertake increasing numbers of cases.
Alan Doherty, clinical director of Birmingham Prostate Clinic, has performed more than 600 laparoscopic (keyhole) prostatectomies. This is a complex operation, undertaken by a very small number of surgeons in the UK.
The audited data, covering laparoscopic prostate surgery results from June 2003 to May 2008, is published here.
“Most patients will make decisions about what surgery they have based on clinicians’ surgical outcomes rather than the type of technology used
(eg laparoscopic or robotic)”
The UK Prostate Cancer Advisory Group.
Operating times
This is the standard measure used to assess a surgeon’s performance. As the surgeon builds up experience of a procedure, operating time is generally reduced, reflecting increasing efficiency in that procedure. While this is a useful measurement, it is less directly relevant to clinical outcomes for the patient than other measures.
Continence
Continence is a recognised complication of prostatectomy. This is because removing the prostate disturbs the area between the bladder and urethra, which carries urine out of the body. During the first three months following surgery, three quarters of men will experience some form of incontinence, typically mild leaking. Mr Doherty has introduced nerve-sparing techniques designed to reduce damage to the area surrounding the bladder.
Ultrasensitive PSA nadir
The standard test to assess whether men are at risk of prostate cancer is a blood test, known as a PSA test. PSA stands for Prostate Specific Antigen, a protein made by the prostate which naturally leaks into the bloodstream. The PSA test is used to assess whether a patient is at risk from prostate cancer; a high PSA indicates cancer may be present. PSA is also used to assess the effectiveness of prostate cancer treatment three months after the treatment has been completed. A highly sensitive PSA measurement is used in order to detect the smallest amount of the protein. A score equal to or below 0.01ng/ml is considered to be optimal, indicating the treatment has eliminated all cancer cells.
Erections
Erectile dysfunction is a recognised complication of prostatectomies. Reported rates of erectile dysfunction vary widely. A traditional radical prostatectomy is undertaken using wide margins around the prostate, damaging the nerves which control the blood supply to the penis. Mr Doherty is among a small group of specialised urological surgeons undertaking nerve-sparing prostatectomies . The task of safely removing all cancer cells without harming the hair-thin adjacent nerves demands a very high level of technical skill.
Margins
Positive margins is the term used to describe any evidence of cancer cells at the edge of the removed prostate tissue. This would present a risk of some tumour cells remaining in the surgical field and therefore a threat of the cancer returning. In a traditional radical prostatectomy, a significant amount of the nerves and tissues adjacent to the prostate are removed and the risk of positive margins has tended to be lower. A nerve-sparing procedure demands greater technical skill to preserve the adjacent nerves but ensure all malignant cells are removed.