Nerve-sparing prostatectomy testimonial – Dr R.Commander

When Dr Richard Commander was diagnosed with prostate cancer, he chose nerve-sparing prostatectomy. A nerve sparing prostatectomy involves precision surgery aimed at removing all the cancer cells and at the same time, preserving the adjacent nerves. This reduces the risk of impotence and incontinence.

Surgeon Alan Doherty is one of the UK’s most experienced specialists in nerve-sparing keyhole prostatectomy. Dr Commander, who is a GP, describes his experience of prostate cancer and nerve-sparing surgery.

“I had developed a urinary infection and I’ve always believed they should be thoroughly assessed, so I was referred to a urologist. We discussed whether to do a PSA test. My father was diagnosed with prostate cancer at the age of 70 and I thought I ought to have the test.

“My reading was 4.9 and we thought it may be prostatitis, as a result of the infection. For four months, I had regular PSA tests and my readings ranged from 4.95 in the second test, 5.9 at its highest and the final reading was 5.2. At that point, the urologist recommended a biopsy.

“I was given the diagnosis of prostate cancer just before Christmas, which was pretty awful, although of course there is no good time to find out you have any form of cancer. I spoke to a urologist colleague, but he only did open prostatectomies and could not guarantee being able to spare the nerves that enable normal erectile function.

“Laparoscopic prostatectomy seemed like a better bet – open surgery involves operating in a deep, dark hole, whereas during laparoscopic surgery, there is a greater capacity to see what you are doing.

“A local surgeon had carried out 15 laparoscopic prostatectomies, with a waiting time of three to four months. My wife was the one who felt that wasn’t a very large caseload and suggested the Birmingham Prostate Clinic because Mr Doherty had carried out far more procedures.

“I also met an oncologist and discussed radiotherapy, which did have a certain amount of appeal. I had the same problem as a lot of my patients – you are given all the options and have to make a choice, which is very difficult. If you have many other forms of cancer, by contrast, your treatment programme is set out for you.

“I felt surgery was the best option for me and I became focused on achieving nerve-sparing surgery. I had my operation at The Priory in Birmingham on a Thursday. I felt quite comfortable immediately after surgery and don’t recall being in any significant pain at any stage.

“I went home on the Saturday and was immediately able to walk to my local hospital in Bridgnorth to get my dressings changed. Two weeks after surgery, I went for a 30 minute jog, which rather surprised and amused Mr Doherty.

“Three months after surgery, I was able to run 10 miles.

“In terms of nerve-sparing, I have been really pleased with the results. I was able to discard my pads, on a day-to-day basis, from six weeks post-op, just wearing them occasionally, such as when I went for a run. By three months, I was completely dry.

“I find Levitra really helpful in terms of restoring my erectile function. Four months after surgery, I have about 80 per cent erectile function when I take 20mg of Levitra. I don’t have any doubts about full erectile function returning by 12 months post-op, as we are already not far away just four months after surgery.

“Taking Levitra is not a problem – you know it will work and it gives you confidence. I anticipate that eventually I will not need it.

“I always felt I could have coped if the nerve-sparing results had not been so good. But once you reach three months after surgery, it is nice to know that everything works and is settling down very well. It was important to my wife that I would be fully dry and for me personally, having nerve-sparing surgery has helped me to feel that I’ve put the experience of surgery behind me and that I am able to move on.”