Consoles and lasers have transformed my job as a urologist
Nudged awake by the wet noses of our two Labradors, I get up at 6am and grab some breakfast. I feed the dogs and two cats, check e-mails and sort out last-minute paperwork for the day ahead.
Then it’s off in the car to wherever I’m based that day – it could be Windsor, Ascot, Maidenhead or London. Thursdays are always just NHS work while the rest of the week is taken up with a mixture of private and NHS appointments, going to multi-disciplinary meetings and discussing individual patients for more precise medical recommendations.
Before surgery starts at 8am I always see my patients. I will talk to a man while his wife looks on anxiously about life-threatening prostate cancer for which he is about to have a Da Vinci prostatectomy (robotic prostate removal). I will show a man an enhanced MRI of his prostate and where a cancer may be prior to performing targeted biopsies by placing needles through the skin between the anus and scrotum.
To discuss the day’s operations, the nurses and I then huddle together around the most popular place in the hospital – the coffee cart, started up by entrepreneurial eastern Europeans and serving extra-strong coffee!
The rest of the morning is taken up with operations. I sit at a console looking into a 3D visual display remotely operating instruments to separate the prostate cancer while gently protecting the delicate nerves that hold the prostate in a hammock. Later, I may use a laser on someone who has prostate enlargement to dissect and vaporise the inner enlarged prostate from the rest.
I first become interested in urology and prostate cancer when I was carrying out my research fellowship at Imperial College London into bone metastasis (the spread of cancer into the bone). So when a consultant post came up in urology I knew that was what I wanted to do.
Prostate cancer is a particularly fascinating and challenging area because, unlike many other cancers, there is no set diagnostic or treatment pathway. This means you have to treat each patient on an individual basis, taking account not just of their cancer, but also their lifestyle, family situation and hopes for the future. You make decisions with them, not for them, and this has made me a more receptive and empathetic doctor.
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The potential side effects of prostate cancer treatment, for example loss of potency or bladder function, can be life-changing and I am passionate about trying to improve outcomes for my patients.
The afternoons are like the mornings in their variety. I see men in my clinic who are at risk of prostate cancer or who may have it, and use enhanced MRI scans and genetic tests to establish the risk of serious disease. I work with Macmillan cancer nurse specialists to counsel men about their level of risk and the treatment options, as well as how to recover their erectile functions.
I usually finish around 8 or 9pm after checking my patients and doing some admin like writing up or dictating notes, and scanning images. I used to carry large piles of notes around with me, but not anymore – everything being electronic has made work a lot easier and more productive.
Evenings are usually dinner with the family and catching up with a TV box set. I am on call every fifth weekend but otherwise will watch my two boys play rugby and football or go sailing and windsurfing off the Dorset coast.
The challenge is to keep learning new skills because the prostate cancer world is always changing. I want to specialise more, do more focal and less invasive surgery.
My field has changed enormously in recent years which has improved outcomes immensely and will continue to do so. As diagnostic technology becomes more advanced we will be able to determine which cancers need treatment and which can be left alone which should mean far fewer interventions and far fewer men and their families, living with the devastating consequences of prostate cancer – great news for everyone.
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