Dr Cahill was excellent with me in terms of my surgery and ma de me feel reassured with all my treatment.

Including some notes here on my experience of the RARP procedure that I previously sent to Mr Cahill, which will hopefully be of use to other prospective patients:- Background I started out from a position of being a moderately fit 53 year old – typical exercise regime prior to preparing for surgery was running 5k once every 7-10 days, with one or two 30-35 minute sessions on an exercise bike in between. I’m 5’11” and weigh around 71-72kgs. No health issues other than the prostate, which was diagnosed as Gleason 3+4 with good prospects for a successful surgical outcome. Preparation for surgery General fitness:- - I increased my exercise regime to running 5k weekly, and doing 35-40 minutes of reasonably high intensity work on my cycling machine 2-3 times a week. I also went for walks every day to the extent I could fit them around work. I was keen that by the time I went for surgery I should be about as fit as I could be, in order to assist my recovery. Pelvic floor exercises:- - I downloaded the Squeezy app, setting it to remind me to perform the exercises 3 times per day (10x slow, 10x fast each time). I was pretty conscientious about doing these every day from about 6-8 weeks before my surgery - In the last couple of weeks pre surgery (having by this time watched the video on pelvic floor exercises), I also did stomach crunches while squeezing my pelvic floor – I did this as part of my daily core strength exercises Core strength exercises:- - As recommended I did about 10-15 minutes of core strength exercises every day, gradually building up the intensity of these over about 8 weeks in the run up to surgery - By the last week, my daily exercises typically comprised the following:- o Plank – 90 seconds o Side plank on one side, then on the other – 75 seconds on each side o Advanced bird dog – 10 repetitions on each side o Plank o Side plank on one side, then on the other o Stomach crunches while squeezing pelvic floor as per the video o Plank - The above exercises all have the advantage of not requiring any equipment, so I was able to do them in a quiet space at work if I was not at home. If I was at home, then I sometimes switched up to include the twist with medicine ball and / or the crunches with medicine ball. I don’t have a medicine ball, so used a small dumb bell of approx. 4-5 kgs instead, held in both hands. - It is worth noting that when I started, I was only able to manage about 30 seconds or so for the planks and side planks, so the exercises produced a quite noticeable increase in core strength over the time that I was doing them. Surgery and recovery - My surgery was a relatively straightforward one, as my cancer had been detected at an early stage (Gleason 3+4), and Mr Cahill was able to plan for and perform a fully nerve-sparing procedure. - I elected for the spinal anaesthetic (reasoning that if anaesthetists are able to administer the spinal anaesthetic safely to women in the midst of labour contractions, then I should be a relatively straightforward case for them). - I woke up in the recovery room feeling well, without any significant pain. On returning to the ward I was able to eat without any problems, and was dosed regularly with paracetamol and ibuprofen. At no stage did I experience really significant pain, however the catheter was very uncomfortable, particularly up until it was secured to my leg (which took a couple of goes to get into the optimal position), and in the afternoon on the day after my surgery my shoulders became very achy, and I was given a more powerful painkiller to help with this. That pain did not return when the painkiller wore off. I didn’t experience any particular pain or discomfort from my wounds. - The catheter remained a source of significant discomfort for about 5 days, at which point I figured out how best to position things and it became more comfortable, but was still a limiting factor in terms of general mobility. Once this discomfort had eased, I stopped taking ibuprofen (6 days post surgery). - When I was at home, before my catheter was removed, I was averaging about 1000-1500 steps per day. Catheter removal My catheter was removed 7 days after surgery. A few points to note on this:- - I was given an extra tube with a tap in it, to use from the evening before removal of the catheter. This helps to reawaken the body’s normal response to a full bladder before you arrive at the hospital for the TWOC procedure, and it certainly worked for me. I had no problems providing the required samples promptly after my catheter was removed. - I had bought Tena pads in anticipation of potential continence problems, and I would recommend this to others – even if you end up not needing them, it is reassuring to know that you have any leaks covered. - I was expecting the catheter removal to be painful, but for me it was no more than uncomfortable and for literally only a second. However the relief of it having been removed is immediate. I was also expecting everything to feel sore afterwards, and it actually didn’t. - After drinking a good amount of water to provide urine samples as part of the TWOC procedure, I needed to pee a couple of times on my way home from the hospital. You should plan your travel arrangements such that there are toilet facilities on your route. After the catheter had been removed, I immediately felt able to be much more active. My catheter was removed on the Monday, and by the Thursday of that week I was up to over 7,000 daily steps, and by the following Monday (two weeks after surgery) up to 12,000 steps. I stopped taking paracetamol on the day after the catheter was removed (8 days post surgery), and have not experienced any pain since then. Continence and erectile function I wore a Tena pad on the drive home from the hospital, and overnight on that first night, but I have not worn one since. Subsequently I have had a few (no more than 3 or 4) instances of dribbles – so my specific advice here would be – be careful when you pass wind; when you restart the pelvic floor exercises make sure you do them with an empty bladder; and when you do go for a pee, don’t be in a rush to pull your underwear back up before you’re sure you have definitely finished… While I reintroduced them cautiously, I have had no problems from drinking coffee or alcohol. I am still (after nearly 5 weeks) going to the toilet more frequently than I did before the surgery, but this is returning to a pretty normal level now. I typically get up to pee once or twice in the night, but the frequency is definitely still reducing. In relation to erectile function, I was fortunate that my surgery spared both nerve bundles. I began experiencing the beginnings of erections while I still had the catheter (in the first week after surgery), which was quite disconcerting; once the catheter had been removed – in week 2 - I started achieving full erections again, although not for a significant length of time. On Mr Cahill’s advice I started taking Tadalafil at the start of week 3, and since then my erections have been no different from those I was having before the surgery, which is a huge relief. General recovery As soon as I was confident that there were no issues with continence, I was able to get back quite quickly to relative normality – for example going out for lunch with family a couple of times, less than 2 weeks after my surgery. As noted above, I have been doing a lot of walking, having built up my step count quite quickly after surgery. I did plan my route so that there would be places to sit down at various points. While I was doing quite a lot of steps as early as the beginning of week three, I found it was helpful to sit down for a few minutes after walking for about half an hour at a stretch. Now – towards the end of week five, I am able to walk for 90 minutes without stopping. I started driving again after 3 weeks, and have not had any problems. My job is desk based and I am able to perform it remotely. While I started to pick up a few admin tasks in weeks three and four, my return to work proper was 4 weeks after my surgery, and has gone fine – I get a bit tired towards the end of the working day, but have had no other issues. I am currently working from home, and will continue to do so until I feel comfortable that the commute (1 hour’s drive each way) will not overtax me. Reflections The speed of my recovery seems to have surprised Mr Cahill. Some of this is most likely down to the fact that I am relatively young and fit (for a prostate patient), and that the surgery went as well as it could have done. However I think the pre-surgery fitness work has also paid significant dividends. I have not experienced any continence issues bar a few dribbles, which attests to the effectiveness of pelvic floor exercises; and I think the core strength work has also been a major contributing factor to how quickly I have been able to get active again – it felt that my wounds never got pulled or stretched when I was standing up, sitting down, or moving around in bed, which I think is because the core strength muscles were doing a good job of naturally holding everything securely in the right position. My overall reflection is that if I had known how quickly and completely I would recover from the surgery, then I would have been less apprehensive about undergoing the procedure. My main concerns prior to the surgery – other than that the cancer should be completely excised - were over whether there would be any lasting issues with continence or erectile function, but these were both almost fully restored within about 2 weeks. For me, surgery was absolutely the right decision, and I would be happy to recommend it to anyone in a similar position to me.

I found Mr Cahill to be engaging, positive, very knowledgeable and informative and he me gave a strong sense of confidence during our meetings / discussions. He explained clearly about what would happen and was also very clear about the procedure / surgery and certain timescales. All of my interactions with him (both face to face and via telephone) reinforced my sense of confidence - which was instrumental in my being quite relaxed in the face of surgery.

Mr Cahill explained my options in clear, understandable terms so I could make informed decisions. I opted for a radical prostatectomy as there was no indication my cancer was more widespread, and we decided together that my prognosis would be best if we delayed my surgery a little while so I had time to address other more pressing health issues like my weight, blood-pressure, chloresterol, diabetes etc to give me the best possible chance of a good outcome. It was the right strategy as it made life much easier for anaesthetist and surgeon alike, also made my recovery so much faster. Mr Cahil made such a tidy job of my robot-assisted surgery that the whole process was pain-free! Outside of the anaesthetic for the actual procedure I didn't require any pain-relief at all, not so much as a paracetamol. I'm left with a series of beautifully tidy little scars, no pain, and most importantly no cancer - he got the lot in that one procedure. If you're on a similar journey to my own, I would absolutely recommend consulting with Mr Cahill. He and his wonderful team made what would normally be quite a scary process (It was my first-ever surgery) drama-free, and of course I'm very happy indeed with the results - cancer-free without the need for either chemo or radiotherapy.

Made me feel confident and reassured in the decisions I was having to make following my diagnosis. He explained the procedures that I would have to go through in words I could understand

Exceptionally professional with a personal approach that was reassuring - thank you Declan Cahill

Top rated consultant who explained everything clearly to me. I felt very confident in his ability to deliver the best outcome. Both pre & post op "bedside manner" was excellent.

Experienced, knowledgeable, lively, caring, intelligent, happy Doctor

Declan recently performed a salvage radical prostatectomy, 5 years after I had received focal treatment (cryotherapy) for a Gleeson 3+4 (grade 2) tumour. Unfortunately, the cancer retuned to another part of the prostate (once again grade 2) and I knew immediately the only option was surgery. I simply could not have been in better hands; Declan's incredible experience and dedication is clear from the outset. He is obviously at the cutting edge of research into how to maximise cancer outcomes whilst minimising side effects; I found his website and explanatory videos all very helpful. In advance of the surgery, I met with Declan's team to help me prepare - the information provided was clear and detailed. The day before surgery, Declan called me to check in; a personal touch that settled nerves. My surgery took just over two hours (despite the complication of prior cryotherapy) and the lack of pain post operation was remarkable (thanks to the recommended epidural). From there, my recovery went very well; Declan's nursing team were so responsive and helpful to the occasional query that I asked; no doubt recovery is a long and in some ways complex road; but I felt utterly supported throughout. But most importantly, the outcome is an undetectable PSA level; good continence from day 1 after catheter removal and better erectile function than expected. I am genuinely in awe of the skill and human care Declan and his team have displayed, and I shall be forever grateful.

I feel very fortunate to have found myself under the care of Mr Cahill. My introduction to the team was as part of a research study at the Royal Marsden but I was transferred to the treatment team when my first biopsy indicated cancerous cells in my prostate. From that point I had regular contact with Mr Cahill's team and further biopsies and MRI scans were organised to check on the progress of my cancer Mr Cahill was always a calming voice when discussing my options and he ensured we did not go into radical treatment mode before I had to. When that time came however, decision to operating time was re-assuringly quick and pre-op info and calls from his team were very thorough. One things that I found particularly impressive was the call the evening before my operation that I received from Mr Cahill asking how things were and how I was feeling about the op - I was not expecting that call but I was very pleased to receive it. The day of my operation was very efficiently handled and one thing I will mention is regarding the comments made by my care team regarding Mr Cahill. The comment that I will most remember was by one of the anaesthetists just prior to receiving my spinal block [which I recommend] who said that if he was in my position, then Mr Cahill was the person he would want to be carrying out the procedure. Just prior to being wheeled into the operating theatre, I found that very re-assuring. I was visited later in the day of my operation by Mr Cahill and again the following morning prior to discharge. The ensuing weeks highlighted what an amazing job Mr Cahill had done on me. Immediately from catheter removal I had none of the urinal issues that I was fearing and I put down in large part to his skills as a surgeon. You will deduce from this that I regard Mr Cahill highly which I do and any patient who finds themselves under his care can be assured that they could not be under the care of a better or more re-assuring surgeon than Mr Cahill