The Questions For Your Consultant Urologist

Mr Alan Doherty

Treatment for prostate cancer is one of the most rapidly developing areas in medicine, providing men with a wide and sometimes confusing range of treatment options.

While our scientific understanding of the disease is marching forward, the culture of the doctor/patient relationship in the UK is changing more slowly. Some patients remain reluctant to ask their consultant many questions. Others may grill their urologist a little more, but steer clear of the question I see as the most important of all: how many of these procedures have you carried out?

In America for example, patients are well practiced in researching treatment options then asking doctors about their experience and outcomes. Much of this data is widely available on the internet. However in the UK, this approach remains rather alien. I do see a growing number of patients who have found my clinic through their own research, rather than a GP or consultant referral. But patients rarely ask how many procedures I have carried out. This is possibly due to a sense of respect; a perception that it may suggest a lack of trust. Yet it is so important. Your ability to perform a procedure safely, effectively, with the optimal outcome for your patient is based, to a very significant extent, upon your experience of that type of surgery.

The number of procedures undertaken by individual surgeons varies dramatically. A surgeon may be trained and skilled to perform a particular operation. That does not mean that he or she is the best surgeon for you. Prostate surgery is a field in which experience can make a critical difference to outcomes. The removal of a prostate (prostatectomy) is technically very challenging because there is a functional aspect to it. You are not only removing a tumour; you must do as little damage to the nerves which control erections and the muscle which holds and releases urine.

Having undertaken more than 2,000 prostatectomies, I know the benefits this experience brings to my work in terms of outcomes for patients. I have also been able to develop my nerve-sparing techniques, reducing the margins between the removal of the tumour and the erectile nerves. This kind of precision work is dependent upon the surgeon continuously using and developing his or her skills by undertaking a large and regular caseload.

To set this into a broader context, the recent publication of cardiac surgery statistics is a major development for the public scrutiny of surgery. However, this is only one, relatively small field, where poor performance of surgeons can, in some cases, contribute to death. In prostate surgery post-operative mortality is almost non-existent. But there are very significant differences for patients in terms of the quality of life they can enjoy after surgery. You are dependent upon the skills of your surgeon to not only remove all the cancer cells, but in doing so, cause as little damage as possible to the adjacent erectile nerves and the bladder. You are most certainly within your rights to ask your surgeon how many procedures he or she has completed and whether your operation can be undertaken as keyhole and nerve-sparing surgery.

I welcome all questions from my patients and their families as this is critical to making an informed choice about the right treatment option for them.