From The Cairman
                  "Diamond Jim" Brady

 


Patrick C. Walsh M.D.
Chairman, Brady Urological Institute
1974-2004

Dr. Walsh revolutionized prostate cancer surgery and improved our understanding of its natural history and genetics.

 

 


It is unusual for one individual to revolutionize a surgical procedure and in doing so have a major impact on a field as important as prostate cancer- the most common cancer and the second most common cause of cancer death in men in much of the Western world. Based on pioneering anatomic discoveries, Patrick Walsh's innovations in radical prostatectomy made it possible to preserve sexual function, improve urinary continence, reduce postoperative mortality tenfold, and decrease progression to metastases and cancer-specific mortality by 50%.

Furthermore, Dr. Walsh and his research team characterized genetic factors involved in the origin and development of the disease, and he demonstrated the value of serial PSA measurements to improve specificity for early diagnosis. Along with Alan W. Partin, M.D., he developed the "Partin Table" to predict probability of cure preoperatively. These graphic representations of numerical relations are also used for men who have recurrence of disease postoperatively, to predict time to metastases and death from the disease.

In the United States as recently as 1980, only 7% of men with localized prostate cancer accepted treatment with surgery because of major side effects: All men had severe erectile dysfunction, lifethreatening bleeding was common, and 10 to 25% suffered severe incontinence. In an effort to reduce this morbidity, Dr. Walsh embarked on anatomic studies and quickly realized that side effects resulted from an imperfect understanding of the anatomy surrounding the prostate, and that it was possible to prevent these side effects through

  1. the discovery of the location of the pelvic plexus that provides autonomic innervation to the corpora cavernosa;
  2. identification and preservation during surgery of the microscopic neurovascular bundles needed to preserve sexual function;
  3. characterization of the venous anatomy of the dorsal vein and Santorini's plexus, which permitted prostate surgery to be performed more safely in a relatively bloodless field;
  4. the delineation of the fascia surrounding the prostate and of the sphincteric complexes, which improved both cancer control and urinary continence.

In making these advances, Dr. Walsh single-handedly changed the prostate cancer field, with his discoveries forming the basis for the anatomic approach to radical prostatectomy that is now used worldwide in open, laparoscopic, and robotic procedures.


Dr. Walsh discovered the location of the pelvic plexus that provides urology in the world.
innervation to the penis, helping to reduce side effects during prostate
cancer surgery.

Over the course of the decade following his discoveries, the 30-day mortality following radical prostatectomy fell tenfold (from 2% to 0.2%), and by the mid-1990s, 34% of men with localized prostate cancer in the U.S. were treated with surgery. Experienced surgeons have reported that serious problems with urinary continence have been reduced to 2%, and in men with normal sexual function who are under age 65, sexual function can be preserved in 60 to 90%.

Validation of the technique’s influence on cancer control was provided by The Scandinavian Prostatic Cancer Group’s randomized controlled trial that compared radical prostatectomy using the anatomic approach developed by Dr. Walsh to watchful waiting.

Dr. Walsh has made a
major impact on the
most common cancer
in men in the Western
world.

They reported that within eight years, surgery reduced progression to distant metastasis and death from prostate cancer by 50%. At ten years, surgery resulted in a significant improvement in overall survival. These findings are relevant to the 25% decline in prostate cancer deaths that has occurred in the United States over the last decade.

In addition to a direct impact on reducing deaths from prostate cancer in this country and abroad, the widespread application of the radical prostatectomy has had a powerful indirect effect by facilitating prostate research. In the days when few men underwent surgery, there was little or no tissue available for pathologic evaluation or biochemical/molecular investigations. Today, tissue harvested from surgical specimens provides an invaluable resource for researchers.

 

Under Dr. Walsh’s
leadership, the Brady
Urological Institute
developed the finest
department of
urology in the world.

Dr. Walsh revolutionized prostate cancer surgery and improved our understanding of its natural history and genetics. He also developed the leading department of urology in the world. In everything he has done, and in all that he has accomplished, his legacy - of steadfast commitment to advancing the mission of the Brady Urological Institute, expanding its impact, and increasing its contributions to the world - will remain an everlasting model for those who follow in his footsteps.