FROM THE DIRECTOR
Lives, Improving Lives,
this issue of Prostate Cancer Update, we report two milestones that
I believe are related:
-The 20th anniversary of the first nerve-sparing operation, and
first concrete evidence that aggressive treatment of localized disease
years ago, the first anatomic radical prostatectomy was performed.
The new procedure overcame many obstacles that had kept urologists
and their patients from accepting surgery as the best form of treatment
for localized prostate cancer.
Before 1982, radical prostatectomy was often associated with excessive,
life-threatening bleeding; as a result, 2 percent of men who underwent
the operation died from it. However, with less blood loss, the operation
became safer, and the mortality rate fell tenfold to where it is
today, at 0.2 percent. Before 1982, all men who underwent radical
prostatectomy were warned that they would be impotent afterward,
and between 10 and 25 percent would have severe incontinence. It’s
easy to understand why many men felt the treatment for prostate
cancer was worse than having the disease itself.
the development of this new anatomical approach, more men accepted
radical prostatectomy. In 1983, only 7 percent of men with localized
prostate cancer underwent surgery.
1993, the number had reached 35 percent. Indeed, in that year, 104,000
men underwent radical prostatectomy.
Within a decade, prostate cancer deaths in the United States plummeted.
In 1993, 43,000 American men died of the disease.
By 2002, the number was down to 30,200. Is there any cause-and-effect
relationship between the rise in radical prostatectomy and a reduction
in prostate cancer deaths by 13,000 a year a decade later? The Scandinavian
story provides some insight.
In this landmark study
from Scandinavia, men who underwent radical prostatectomy were
half as likely to die of prostate cancer as men who were treated
with watchful waiting. This raises the intriguing possibility that
the major cause for the reduction in deaths from prostate cancer
now is the rise in radical prostatectomies a decade ago, simply
because an operation was made safer.
what we know
Men who invested in having a radical prostatectomy over the last
20 years have made a wise decision. Unfortunately, it is not yet
an “equal-opportunity” operation: Not all men have the
availability of a surgeon who is skilled in performing the surgery,
and either are not offered an operation, or suffer needless side
effects. Over the last 20 years, I have worked to perfect this procedure—by
studying videotapes of my own operations, by following my patients
carefully, and understanding their true side effects, by developing
new techniques, and by identifying anatomical variations in men
that might affect their long-term urinary continence and potency.
Now, I have put everything I know about
this operation on a DVD, which I plan to distribute around the world
free of charge, to any urologist who wants to view it. My dream
is that no man with prostate cancer will miss the opportunity to
be cured, and to live a long, happy life free from devastating side
C. Walsh, M.D.
Walsh, seen videotaping a "nerve-sparing"
procedure for worldwide distribution to urologists
PROSTATE CANCER UPDATE
is published by
The James Buchanan Brady Urological Institute,
The Johns Hopkins Medical Institutions, Baltimore, MD 21287-2101.
Patrick C. Walsh, M.D, Urologist-in-Chief
Janet Farrar Worthington, Writer/Editor
Claude Skelton, Designer
Bill Denison, Photographer