For decades, the fear of becoming impotent and incontinent as a result of surgery for prostate cancer kept many men from screening and treatment, resulting in countless deaths that might have been prevented. This has drastically changed in recent years, with the use of new surgical approaches to remove the prostate which spares nerves and tissues in the area and can avoid the dreaded side effects. In addition, many men once thought "incurable" are now able to avoid surgery altogether and live longer with more effective radiation therapy.
The two physicians who pioneered those treatments and were instrumental in changing prostate cancer treatment are Dr. Malcolm A. Bagshaw, Professor Emeritus of Cancer Biology at Stanford University and Dr. Patrick C. Walsh, Director of the Department of Urology at Johns Hopkins University.
In the 1970s, Dr. Walsh embarked on a series of anatomical studies to
delineate the structures surrounding the prostate, in an effort to prevent
incontinence and impotency. Initially, he mapped the anatomy of the dorsal
vein complex around the prostate, and was able to eliminate the severe
bleeding that typically hampered surgery. After noting that one of his
patients was fully potent after the improved surgery, Dr. Walsh set out to
find out why most men became impotent. By dissecting infant cadavers, in
which pelvic nerves and tissues are more clearly seen, he was able to locate
the nerves which supply the corpora cavernosa and give rise to erections.
These nerves had never been charted and it was assumed that they ran
through the prostate, but it turned out that they ran outside the prostate.
By not cutting, or only removing nerves on one side, Dr. Walsh was able to
preserve potency. In 1990, Dr. Walsh charted the anatomy of the striated
sphincter (which controls urination), and refined the surgery further to
avoid damage to the bladder neck and urethra, preventing incontinence.
Dr. Walsh has made other important contributions to the field, including the characterization of familial and genetic factors responsible for prostate cancer. He has established the largest registry of men with hereditary prostate cancer, and has improved the use of PSA in the early diagnosis and staging of the cancer.
Dr. Walsh is the author of The Prostate: A Guide for Men and the Women who Love Them (Johns Hopkins Press, 1995), aimed at the lay public. He earned both his undergraduate (1960) and medical degrees (1964) from Case Western Reserve University in Cleveland, Ohio. Dr. Walsh joined Johns Hopkins in 1974, as chairman of urology.