After 26 years of managing prostate cancer I have learnt that it is critical to have the right treatment for the right patient at the right time. I am also very aware that outcomes need constant monitoring. With this in mind, I work with an amazing team that support me. We strive to deliver complete compassionate care, something we pride ourselves on. Over the last 20 years, the sophisticated research team that monitors our outcomes has helped us tailor treatments. This has enabled me to deliver evidence-based results in a very personal way.
To evolve as a surgeon it has been indispensable to be involved in research. Science has been my greatest ally, allowing me to introduce, where indicated, the latest technologies in diagnostics and surgery. Yet, no matter how advanced we become the final treatment decision is for most of patients not an easy one. Helping a patient with his decision is very much a part of my job. I spend time with each patient and ensure that he and his family are fully informed about the treatments and their possible side effects. I also make sure they have a clear idea of the likely outcome that can be delivered.
Finally, I treat more than just the cancer. The highly skilled and dedicated people I am fortunate enough to work with, assist in providing care for the whole person, working to improve outcomes and quality of life. This integrative approach requires careful planning. I believe that tailoring the right treatment plan for my patients is crucial, and I have put much time into helping patients understand how to choose the right treatment.
Currently, I am performing over 200 cases per annum. With over 1,600 robotic radical prostatectomies, the results of which have been published here in the leading urology journal: European Journal of Urology. The first 1000 patients showed outstanding results in terms of continence and potency and cure rates while maximising the speed of recovery and minimally invasive nature of the da Vinci robot technique. I have developed nerve and vascular preservation techniques to maximise potency. And I have also developed a technique for lymph node dissection which maximises cure rates by removing the possibly-involved lymph nodes with more aggressive tumours. In the European Journal of urology article I drew attention to the relationship between greater experience and improved outcomes - especially in the area of potency.
I write about robotic surgery regularly, especially in ther areas of learning curves (Doumerc et al BJUI 2011) and the ability to nerve-spare even with more expansive cancer (Moore et al BJUI 2011) and the ability to improve early continence results (Beattie et al J . Robotic Surgery 2012). I presented my functional outcomes on potency and continence to the Australasian Urological Association Meeting and the New Zealand Association Meeting and also to Cornell University and to the World Symposium of Robotic Surgery. Sharing the knowledge and skills that I have acquired is important to me and I mentor many robotic surgeons throughout Australasia and South East Asia.
I have performed over 4,000 cases of open surgery - the largest series of open surgery in Australasia and the fifth-largest in the World
Focal therapy using the Nanoknife
Recently I completed Australia’s first focal therapy trial. The trial involved 20 patients who were all treated with the NanoKnife. None of these patients suffered with any ongoing incontinence or impotence. For me this confirmed the safety and minimally invasive nature of this treatment. As far as cancer control goes, the early MRI findings are extremely encouraging and I intends to offer focal therapy as a clinical option for suitable patients.
My low-dose-rate and high-dose-rate brachytherapy cases numbers over 400 and almost 1,000 respectively. This is the largest brachytherapy series in Australasia.
We have over 700 patients currently on active surveillance. They are assessed annually to decide on the most appropriate treatment for their cancer. Almost 1,000 per year being counselled as to the most appropriate therapy - usually given as a 'second opinion'.