Patrick C. Walsh, MD, is the Professor and Director of the Brady Urological Institute at Johns Hopkins Hospital in Baltimore, MD. Dr. Walsh received his M.D. from Case Western Reserve University in 1964 and was a resident in surgery and pediatric surgery at the Peter Bent Brigham Hospital and Boston Children’s Hospital from 1964 through 1967. From 1967 until 1971, he was a urology resident at the University of California at Los Angeles. Dr. Walsh became the Director and Chairman of Urology at Johns Hopkins in 1974. Dr. Walsh currently focuses on perfecting the surgical management of prostate cancer.
Dr. Walsh serves as the Editor-in-Chief of Campbell’s Textbook of Urology, is on the Editorial Board of the New England Journal of Medicine, and is a member of the Institute of Medicine of the National Academy of Sciences. In 1996, Dr. Walsh received the Charles F. Kettering Medal from the General Motors Cancer Research Foundation for “The Most Outstanding Recent Contributions to the Diagnosis or Treatment of Cancer.” With Janet F. Worthington, Dr. Walsh wrote the best-selling The Prostate: A Guide for Men and Women Who Love Them, published by Johns Hopkins University Press in 1995 and by Warner Books in 1997.
MedTech1: Your specialty is radical prostatectomy. What percentage of prostate cancer patients needs to undergo this procedure?
Dr. Walsh: Radical prostatectomy is indicated for prostate cancer patients who are curable and who are going to live long enough to need to be cured. The ideal candidates are men in their 40s and 50s with localized disease, and patients in their 60s who believe it is the best way to cure them.
MedTech1: How does the more traditional prostate cancer treatment, radiation, fit in to radical prostatectomy?
Dr. Walsh: Radiation therapy is another option for the management of localized prostate cancer. It is ideal for patients who are older and whose disease is more advanced. It has not been used commonly in younger patients because of concern about how long its effect truly lasted. Today, there are ways to try to improve radiation therapy using new imaging techniques and higher doses. It will take some time to know whether they prove to be equally effective.
MedTech1: You were the first person to draw a map of the nerves in the pelvis. How did your knowledge lead you to spare the nerves responsible for urinary function and erectile function?
Dr. Walsh: Before the discovery, prior to 1980, everyone who had his prostate removed for cancer was impotent. It was believed that the nerves ran through the prostate. Following an operation in 1977, a patient reported to me that he was fully potent. So I knew that the standard belief that the nerves ran through the prostate could not be correct. But I did not know where they were. I was not until February 13, 1981, that I was able to discover where they are located. Upon that basis, I developed radical prostatectomy.
MedTech1: What percentage of men remains potent after this procedure now?
Dr. Walsh: In men under the age of 65, in my hands, 86 percent of patients are potent following surgery. Previously, it was zero.
MedTech1: What about urinary function?
Dr. Walsh: I tell patients that the likelihood that they will have a long-term, significant problem with urinary control is about 2 percent.
MedTech1: Brachytherapy is another procedure used to treat prostate cancer. Do you see it someday replacing radical prostatectomy?
Dr. Walsh: Brachytherapy was widely used 20 years ago, and it was subsequently shown that it did not completely control the cancer well enough. Unfortunately, many of the men who received it in those days ultimately died from prostate cancer. Today, it is believed that the treatment is better. I am skeptical about this. Actually, we at Johns Hopkins do not offer brachytehrapy as monotherapy, or the only form of treatment for anyone with prostate cancer. I believe if someone wants to have seeds used, it is necessary also to give external beam radiotherapy. To cure prostate cancer, you have to eliminate the entire prostate because these cancers are usually so widely dispersed throughout the prostate. I am skeptical that radioactive seeds alone can accomplish this goal.
MedTech1: How do you present radical prostatectomy as an option to your patients?
Dr. Walsh: I tell my patients what the options are. We do over 1000 radical prostatectomies per year at Johns Hopkins. My biggest problem every day is trying to tell people I cannot take care of them.
Photo courtesy of Johns Hopkins Medical Institutions