Is my surgeon any good?

I found the BAUS site pretty useful although like yourself I asked more questions than I got answers.

I was very reluctant to question the surgeon's competence and decided that as he was head of a surgical unit at a big hospital and did regular operations with what appeared a good outcome he was as good as I was likely to find without losing more time than I wanted or creating what could be a poor atmosphere perhaps to my detriment.  I got the impression he was a person who liked operating and worked at private hospitals and that gave me confidence.  Although you read of rogues you hope and expect they're rare.

I also read the CQC report for that area of the hospital.   Being a sceptic I was also a bit wary of that but it seemed good enough.

I'm not sure if the surgeon can control some of the factors in Lyn's comment.  For example if you have a positive margin what is the surgeon meant to do.  He/she could perhaps say they won't operate but are they to know.  Mine and many other cases are upgraded when they get the prostate into the lab.

On the other hand I met someone who said he was incontinent after 2 years and had been told beforehand it was the surgeon's first operation.  He said he was happy to still be here with an undetectable psa and was willing to put up with anything else.

If you feel you have time you could look up other surgeons but I was told my lesion was near the edge and I didn't want to waste time.   Although to be honest I had confidence in the surgeon so it wasn't an issue.

Edited by member 28 Feb 2020 at 00:15  | Reason: Not specified

Just to be clear, the data I have listed are the % that urological surgeons are required to report to BAUS (with a little interpretation on my part). The small adjustments are

a) surgeons report % continent at 12 months but the NHS considers 'continent' to be 'using one pad per day or less' (which many men would not consider to be continent) and

b) they only have to report how many of their patients can get an erection, not whether the erection is sufficiently hard to use or whether that is with help or natural.

A positive margin is an error, not an unfortunate and unpredictable situation. 

Edited by member 28 Feb 2020 at 00:32  | Reason: Not specified

The more operations a surgeon performs, the better they get.
The NHS has concentrated its procedures into a small number of "vanguard" centres.
So UCLH for instance performs 800 of RARP per year, with each of their 7 surgeons doing between 100 and 150 per year.

I agree with the comments made above regarding continence being a good metric. But a lot depends on the location of your tumour. Your surgeon should be able to give you a good indication of how long it should take you to regain continence in your specific case. But you should start doing pelvic floor exercises now. Get the app.

(The NHS does not give you a choice of surgeon. )

Edited by member 28 Feb 2020 at 07:40  | Reason: Not specified

Hi

Went through a similar journey last Sept/Oct. I asked my local surgeon the same thing. I also got a second opinion as found the same surgeon Bollinge saw. Finding the prof really worked well for me. I had Retzius sparing robotic assisted radical prostatectomy + neurosafe at London Bridge. I went private route as thankfully had kept my insurance running. I’m week 13.5 post op and fully continent albeit it one or two drips in the gym under stress. No noticeable loss of length. No ED issues although now effectively had a vasectomy. Recent PSA bloods <0.01 so at this stage effectively undetectable. No regrets at all and definitely worth finding a pioneering surgeon with high volume and good track record.

Just picking up for clarification on the following point Lyn makes.

'A positive margin is an error, not an unfortunate and unpredictable situation.'

That's the opposite to what I'd always believed.   My reading had always been that the prostate is in effect like a golf ball attached to the bladder with nerves and other organs around it.   

If a lesion was very close to the edge leaving no margin or protruding from the prostate the surgeon can only take out the ball with the protruding or nearly protruding lesion plus nerves and other things.   The lesion would in those cases be a positive margin and there is nothing the surgeon can do about it unless it was next to the bladder when part of the bladder could be removed. 

Even then it could be a positive margin on the prostate.  I've seen photos of lab samples and the definition of margin was whether the lesion was wholly in the prostate.

What % of RP patients have a positive margin? 21% overall. Of these T2 0%, T3 50%

What % need adjuvant treatment? 6% needed adjuvant treatment

What % are still using pads at 12 months post op? 64% no pads, 26% 1 pad, 6% 2pads, 4%>3pads

What % can get an erection sufficient for penetrative sex at 12 months without mechanical or chemical assistance? About 50% (44% with previously good erections)

Overall our units results are generally in the upper quartile case mix adjusted (we do more complicated patients here) and all the surgeons have very similar outcomes. Our T3 margin rate is a bit high because we have more advanced cases. But for the T2 disease such as mine, the T2 +ve margin rate, length of stay and blood loss are all good

Recommend scoping out surgeons who use Retzius sparing approach. The continence stats are compelling. I can only speak for me but game changer. 

TG