THE BEST PROSTATE CANCER SURGEONS

CHOSEN BY FELLOW DOCTORS

What are the hallmarks of a good doctor? technical expertise and skill, of course — but someone who understands you, someone you trust, is also vital.

Indeed, research shows that a good relationship with your doctor can actually improve the chances of a successful outcome.

But how do you find a specialist who fits the bill? that’s where this unique series of guides, running every day this week in the Mail, can help.

We’ve identified the country’s top consultants — as judged by their peers. We’ve canvassed the views of more than 260 consultants across seven specialties from around the country, and asked them this very simple but key question: ‘If your own nearest and dearest were to need treatment in your field, to whom would you refer them — and why.’

the consultants who earned the most votes from their own peers are the ones who made it into our guides. though patients should bear in mind that this is not a scientific study and there are many superb and highly skilled specialists all over the country who didn’t make it onto our list but who spend every day of their working lives making a real difference to patients.

to help you make informed decisions about your care, we’ve also talked to experts about the latest thinking on treatment.

DO YOU REALLY NEED AN OPERATION?

ask most people how prostate cancer is treated and the chances are they’ll say ‘surgery’. In fact, surgery — removal of the prostate — is just one weapon in the arsenal of procedures.

Radiotherapy, chemotherapy and hormone treatment have as big a part to play for many patients and, increasingly, urologists advocate ‘active surveillance’, where patients are regularly monitored to keep tabs on the tumour.

this means they can avoid unnecessary treatment, but it gives them the option to decide on surgery in the event the tumour changes. active surveillance is earmarked for patients with low-risk cancer which hasn’t spread beyond the prostate.

‘In the past, we’ve tended to couple cancer diagnosis with treatment,’ says anthony koupparis, a urological surgeon at southmead hospital in Bristol.

‘What we are now doing is disconnecting that process so, at the point of diagnosis, we put the brakes on and have a discussion with the patient and explain the type of cancer they have. If it’s not life threatening, I will tell the patient they genuinely don’t need an operation.

‘Every now and then I will get a man who, despite the very early low-grade nature of their cancer, cannot deal with the thought of living with it,’ adds Mr koupparis. ‘I will give him lots to read on the subject and if he returns and says he can’t deal with living with an untreated tumour, then I will definitely operate, if that’s what he wants.’

avoiding needless treatment is driven by the fact that surgery to remove the prostate (radical prostatectomy) and radiotherapy can leave men incontinent and impotent as a result of damage to muscles and nerves.

around 15 per cent of prostate cancer patients have surgery. Up to a quarter will suffer temporary urinary leakage afterwards, although only two out of 100 men have major problems with urinary incontinence one year after surgery, according to Cancer Research Uk.

Erectile dysfunction can also be a problem. It is ‘realistic’ to expect some problems with erectile dysfunction after surgery, according to Jane Brocksom, a senior nurse specialist in urology and Vice President of the British association of Urological Nurses. But ‘most men will have only mild issues’ and sexual function can return.

however, it’s important to note that many men may have had such problems before diagnosis.

‘a lot of prostate patients say that their waterworks and erections are fine, but when we check the questionnaires we ask them to complete, you can see those functions aren’t normal,’ says Mr koupparis.

the risk can be reduced with a technique known as nerve-sparing prostatectomy (which may be possible when the cancer is low grade and hasn’t spread beyond the prostate).

around six out of ten men will be able immediately to have an erection if the surgeon is able to spare the nerves during surgery, says Cancer Research Uk. the technique involves protecting the nerves by peeling them away before removing the prostate.

the prostate is removed with a small rim of surrounding tissue and sent to a pathology lab where it is examined under a microscope to see how close to the margins of the gland the cancer has spread.

surgeons want a cancer-free margin of tissue around the prostate to be certain no cancer cells have been left behind.

however, labs take three days to process the result, so in borderline cases — men with larger and more aggressive tumours which might pose a threat to the nerves — the surgeon makes a judgment based on what he can see and scans and tests carried out beforehand.

Does he take a belt and braces approach, and sacrifice the nerves to be sure the cancer is controlled? Or should he spare them to optimise potency?

a new form of nerve- sparing surgery shows promise in helping men preserve their erections without compromising their long-term health.

Neurosa-FE speeds up the pathology process so that conclusive results are given to the surgeon while the patient is still on the operating table. a

study at the NHS Lister Hospital in Stevenage, Hertfordshire, where NeuroSAFE is now routinely offered to all patients who stand to benefit, 74 per cent of men who were able to have erections before surgery were still able to a year after, compared with 45 per cent of men not assessed with it.

But the real seismic shift in prostate cancer treatment has been the arrival of the Da Vinci robot — where a surgeon remotely controls three or four robotic arms over the patient lying a few feet away. Robot-assisted prostatectomies now constitute 80 per cent of all prostate removal procedures in the UK.

The £1.5 million cost of a robot has led to prostate cancer treatment shifting to major centres in cities such as London, Bristol, Newcastle and Canterbury. This in turn has reduced complication rates and improved outcomes for patients, because the number of prostatectomies each surgeon performs has soared.

As Declan Cahill, a urological surgeon at the Royal Marsden Hospital in London, explains: ‘ The link between high volume [large number of operations performed per year] and good outcomes is undisputed.’

Professor Chris Eden, a urological surgeon at the Royal Surrey County Hospital, says he wouldn’t ‘send my own relative to anyone doing fewer than 100 prostatectomies a year — that’s what you need to maintain consistently good results. That may seem unfair to urologists doing fewer, but surgeons have no God-given right to do an operation.’

You can check how many prostatectomies each surgeon carries out on the British Association of Urological Surgeons website ( baus.org.uk — search under Patients).

Surgeons are also required to submit some of their results on the website. Good urologists will record not just their mortality and complication data but also the ‘functional outcomes’ — in other words, results for continence and erectile function.

In any event, prospective patients should certainly ask a urologist about their results — and be cautious about anyone who is less than forthcoming.

But what are the other hallmarks of a good urologist? We set out to identify not just those consultants who get consistently good results but those judged to be outstanding by their peers. We canvassed the views of around 40 urologists from around the country on who are the top performers — here we reveal their choices, with a selection of the personal comments about why they chose them.

THE PROSTATE CANCER SURGEONS THEIR PEERS RATE

DECLAN CAHILL

Royal Marsden Hospital in London WHAT THEY SAY

ABOUT HIM: ‘ An incredibly talented young surgeon and one of the highest volume surgeons for prostatectomy in the country [ie, he performs a large number of operations],’ says one urologist. ‘I’ve seen him operate and he is outstanding.’

‘He pays great attention to detail and is passionate about getting good outcomes and striving to do better — he’s extremely self- critical and analyses his results, which is the only way of assessing your performance to see how you can improve it.’

‘Declan is very approachable and caring and patients love him,’ says another. ‘ He is open to discussing anything with his patients: his aim is not just to do the surgery but to look after the whole person.’ PRIVATE PRACTICE: The Royal Marsden Hospital (private care), London Bridge Hospital, The Princess Grace Hospital, Parkside Hospital, both in London.

PROFESSOR CHRIS EDEN

Royal Surrey County Hospital in Guildford WHAT THEY SAY

ABOUT HIM: ‘He was the leading keyhole surgeon with prostatectomies — his cancer margins were one of the lowest in the country [in other words, no cancer cells were found at the edge of the removed prostate] — and has since switched to the robot,’ says one urologist.

‘He’s excellent, immensely skilled, very tidy and does a large number [high volume] of prostatectomies,’ says another.

He has pioneered retzius-sparing prostatectomy in this country — where the prostate is approached from beneath the bladder rather than above, which shows promise in providing early return of continence, although other surgeons are sceptical about the technique.

PRIVATE PRACTICE: BMI The Hampshire Clinic in Basingstoke, BMI Mount Alvernia Hospital in Guildford, London Bridge Hospital, Nuffield Health Guildford Hospital.

JIM ADSHEAD

Lister Hospital in Stevenage WHAT THEY SAY ABOUT

HIM: ‘A very high quality surgeon. Technically excellent, he’s also a very caring doctor who spends time very carefully explaining things to his patients,’ says one urologist.

According to another: ‘ He has pushed the boundaries with the NeuroSAFE technique [see previous page] he brought to this country, which shows great promise controlling cancer and helping patients maintain their erectile function.’

A study is set to start shortly to see if it is cost-effective; if so, it’s likely to be taken up more widely by other centres around the country. PRIVATE PRACTICE: Spire Harpenden Hospital.

ALAN DOHERTY

Queen Elizabeth Hospital in Birmingham

WHAT THEY SAY ABOUT HIM: ‘A keyhole surgeon who does huge numbers of prostatectomies, including nerve- sparing, and is immensely skilled and kind. Frankly, the tool — be it a robot or scalpel doesn’t matter, the outcomes do and his are very good,’ says one urologist.

From another: ‘He gathers his data meticulously, the hallmark of the best surgeons.’ PRIVATE PRACTICE: Birmingham Prostate

Clinic, Spire Parkway and Little Aston Hospitals.

PROFESSOR NOEL CLARKE

The Christie Hospital in Manchester

WHAT THEY SAY ABOUT HIM: ‘An absolute authority and a leader in the field nationally,’ were the words of one of those who nominated him. ‘He knows his subject inside Not only is he a very good technician — in other words, surgeon — but he is up on the very latest in terms of the evidence from trials on treatments, anything that might potentially help his patients.’

‘An excellent opinion,’ was another comment about him.

PRIVATE PRACTICE: The Christie (private care).

PRASANNA SOORIAKUMARAN

University College Hospital in London WHAT THEY SAY ABOUT

HIM: Known as PS, ‘he’s an outstanding robotic surgeon on who drives clinical research

in urology in this country — he has looked into surgical measures to improve continence following robotassisted prostatectomy, because this boosts quality of life for patients,’ says one urologist. Another adds: ‘He is measured and cares deeply about getting good outcomes and also considers the whole person he is treating. One of the ones to watch.’ PRIVATE PRACTICE: London Bridge Hospital, The Princess Grace Hospital in London.

CHRIS OGDEN

Royal Marsden Hospital in London WHAT THEY SAY ABOUT

HIM: ‘An excellent high volume [performs a lot of prostatectomies] surgeon who is neat and skilled,’ according to one of his peers. ‘He was one of the first to take up robot-assisted prostatectomy in this country and he gets very good results for his patients.’ PRIVATE PRACTICE: BUPA Cromwell Hospital in London.

ALSO HIGHLY THOUGHT OF...

WILLIAM CROSS

St James’s University Hospital in Leeds

WHAT THEY SAY ABOUT HIM: ‘A great surgeon with a very keen mind, good eye, who operates well and thinks sensibly.’ PRIVATE PRACTICE: Nuffield Health

Leeds Hospital, Spire Leeds Hospital.

PROFESSOR NAEEM SOOMRO

Freeman Hospital in Newcastle WHAT THEY SAY ABOUT

HIM: ‘A fabulous surgeon and an all-round good egg. He leads the robotic programme in Newcastle and would make sure my relative would be well taken care of.’ PRIVATE PRACTICE: Nuffield Health Newcastle Upon Tyne Hospital.

PAUL CATHCART

Guy’s & St Thomas’ Hospital in London WHAT THEY SAY ABOUT

HIM: ‘ Technically extremely good, he thinks about what he does very carefully and does it very well.’ PRIVATE PRACTICE: The Princess Grace Hospital in London.

BEN EDDY

Kent & Canterbury Hospital

WHAT THEY SAY ABOUT HIM: ‘Very well-trained — he honed his surgical skills with a fellowship in Australia and you’ve got to be dedicated and motivated to do this,’ says one surgeon.

‘He is focused and passionate about what he does and is well-liked by patients, and well thought of among peers,’ says another. PRIVATE PRACTICE: London Bridge Hospital.

ANTHONY KOUPPARIS

Southmead Hospital in Bristol WHAT THEY SAY ABOUT

HIM: Like Ben Eddy, he undertook a fellowship (in Vancouver — ‘ one of the leading centres for prostate cancer,’ says one surgeon).

‘ One of the country’s highest volume prostatectomy surgeons [he does a large number of operations],’ says another. ‘ He is meticulous,

measured and gets good results. He is also good at making decisions on who will benefit most from surgery.’

PRIVATE PRACTICE: Bristol Urology Associates, Spire Bristol Hospital, Nuffield Health Bristol Hospital.

BIJAN KHOUBEHI

Chelsea & Westminster Hospital in London WHAT THEY SAY ABOUT

HIM: ‘Put simply, he is just a really good doctor. Despite being a surgeon by training he is someone who would never operate if there were other options.’

‘Straight-talking and honest and very experienced, he looks after patients from start to finish and will see things through if there are any complications.’

PRIVATE PRACTICE: London Urology Specialists, The Lister Hospital in London, The London Clinic.

NIMISH SHAH

Addenbrooke’s Hospital in Cambridge WHAT THEY SAY ABOUT

HIM: ‘A very good, high-volume surgeon [he does a large number of operations]. I have watched him operate and he has beautiful skills and is a very balanced opinion — in other words, he will be honest about all the treatment options, not only surgical.’ PRIVATE PRACTICE: Nuffield Health Cambridge Hospital, Spire Cambridge Lea Hospital.

KRISHNA NARAHARI

University Hospital of Wales in Cardiff

WHAT THEY SAY ABOUT HIM: ‘An up and coming urologist,’ says a senior colleague who observed him. ‘I was amazed at how good he was. He has this natural aptitude and is meticulous and careful about analysing his outcomes. Monitoring your own results is the only way of examining how you are doing and where you can improve.’ PRIVATE PRACTICE: Spire Cardiff Hospital.

JONATHAN ANING

Freeman Hospital in Newcastle WHAT THEY SAY

ABOUT HIM: ‘ He undertook a fellowship in Canada — and extra international training is invariably a sign of dedication,’ comments one.

‘I really like the way he operates and deals with patients. His approach is calm and comforting and he gets good cancer clearance margins — which is what surgeons strive for, because it means there is less of a chance of relapse.’ PRIVATE PRACTICE: Mr Aning does not work privately.

PETER COOKE

New Cross Hospital in Wolverhampton WHAT THEY SAY ABOUT

HIM: ‘Excellent surgeon and a really nice, caring chap who is technically very good and works very hard, constantly trying to improve his results.’ PRIVATE PRACTICE: BMI The Priory Hospital in Birmingham, Nuffield Health Wolverhampton Hospital.