The Impact of Anatomic Radical Retropubic Prostatectomy on Cancer Control:
30 Years of the "Walsh Procedure"
PSA recurrence, metastatic disease, and prostate cancer death
have decreased dramatically in men treated in the PSA era (after 1992).
Before 1982, not many men wanted to undergo radical prostatectomy, because the cure was considered as bad as, if not worse than, the disease. Impotence was universal, and incontinence was more common than not. The operation was also notorious for the excessive bleeding that went along with it. But then surgeon Patrick C. Walsh, M.D., discovered the location of the nerves responsible for erection. They were where no one had suspected – outside the prostate – and did not necessarily have to be removed along with the prostate. He also developed techniques to create a "bloodless field," to reduce the terrible blood loss and allow the surgeon better vision of the anatomic terrain during the procedure which, in turn, produced a dramatic reduction in incontinence as well as impotence. These discoveries marked the birth of the "nervesparing" radical prostatectomy, the "Walsh Procedure," which has become the gold standard for treatment of prostate cancer.
| The Bottom Line
The study's most important finding was that men treated after 1992, when PSA screening was introduced, did much better. Because screening allowed men to be diagnosed earlier, these men were far more likely to have organ-confined disease. As a result, PSA recurrence, metastatic disease and prostate cancer death occurred much less frequently among men treated in the PSA era.
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