Marking a Milestone in Prostate Cancer Treatment Twenty-five years ago, Dr. Patrick Walsh entered an operating room at Baltimore's Johns Hopkins Hospital and revolutionized the treatment for prostate cancer.
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Marking a Milestone in Prostate Cancer Treatment

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Marking a Milestone in Prostate Cancer Treatment

Marking a Milestone in Prostate Cancer Treatment

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ROBERT SIEGEL, host:

This is ALL THINGS CONSIDERED from NPR News. I'm Robert Siegel.

MELISSA BLOCK, host:

And I'm Melissa Block.

Today marks an anniversary in the history of prostate cancer surgery. Our co-host, Michele Norris, went to Johns Hopkins Hospital in Baltimore last evening and has the story.

MICHELE NORRIS: Twenty-five years ago today, Dr. Patrick Walsh entered an operating room in Johns Hopkins Hospital and revolutionized the treatment for prostate cancer. The year was 1982, and at that time, treatment options for prostate cancer were limited. Surgery could control the disease, but it also created major side effects - extreme blood loss, no bladder control, and in all cases, impotence.

Dr. Walsh's surgical innovation was based on a suspicion that doctors did not really understand the complex tangle of veins and nerves that surround the prostate.

Dr. PATRICK WALSH (Prostate Cancer Surgeon, Johns Hopkins Hospital): What I discovered were anatomic principles and those anatomic principles are now widely applied everywhere because it's the anatomy. Urologists stop me at meetings and say thank you for developing that. My patients are now able to have a safe operation. And over the next 10 years, the mortality from the operation dropped tenfold.

(Soundbite of party conversation)

Unidentfied Man: How are you? Good to see you.

NORRIS: Yesterday, Johns Hopkins threw an anniversary party to honor the 69-year-old Dr. Walsh and the man known as patient number one.

Dr. WALSH: I'd like to - this is the man of the hour - our first patient.

NORRIS: At this cocktail reception, two men seemed to smiling more broadly than almost anyone else in the room. The fellow with the sparkling blue eyes and the small, pink whales on his tie - that's Dr. Walsh. And a few steps away is his pioneering patient, a retired professor named Robert E. Hastings.

(Soundbite of party conversation)

NORRIS: The two men are now friends. But 25 years ago, they met for the first time as a weary cancer patient and a confident doctor.

Mr. ROBERT E. HASTINGS (Retired Professor; Former Prostate Cancer Patient): In my mind, a good surgeon has to have a good presence of himself, and I could see that right away.

NORRIS: So I know that this was more than two decades ago, but do you recall -was there something that Dr. Walsh said or something that he did that put you at ease? That let you know that you were with the right man?

Mr. HASTINGS: Well, I got a kind of a kick out of it, he just looked at me and said, you know, I can cure you. And I said, well, that's what I like. He's really positive, you know, no hemming or hawing. He said, I can cure you, you know.

NORRIS: Now if can turn to Dr. Walsh. This was 25 years ago, what was that confidence based on?

Dr. WALSH: It was based on knowledge. When I came in 1974 to Johns Hopkins, the place where radical prostatectomy was first developed, it was hardly ever performed. And that was because there were so many side effects - tremendous bleeding. Everyone was impotent. You had to tell every patient he'd be impotent. And about 10 to 25 percent of the patients were left with no urinary control. The side effects essentially were worse than the disease.

And I set out to wonder why those side effects occurred and could they be prevented. And the first one that kept surgeons from doing the operation was the frightening blood loss. And it occurred because we did not know where the veins were surrounding the prostate.

And so I embarked upon operations where I looked to see where those veins were. And despite the fact that they are beneath very dense tissue, I was able to discern that there was a common channel that could be controlled. And when I did that, bleeding was no longer a problem.

NORRIS: Now, what happened after that first surgery? Did you know immediately that you had success or did you have to wait a period of days at least?

Dr. WALSH: Well, I didn't. I have - Mr. Hastings was very, very good about being very open about his recovery process. And four days after the catheter was removed, Mr. Hastings awoke during a dream with some demonstration of erectile function. And we should say, and 25 years later, his cancer has also been cured.

NORRIS: Now, you say that now with a certain nonchalance, but at the time this was...

Dr. WALSH: Groundbreaking. And, you know, we went from having everyone being impotent to being able to tell a patient that you could preserve potency and be able to do it.

NORRIS: What did it mean to you as a physician to be able to deliver that news to someone?

Dr. WALSH: Well, I assumed that's what I was on this earth to do, to be honest with you, and I was terribly excited about it and I thought that this could have profound implications on how prostate cancer would be treated in the future, and profound impacts on the quality of life for men. And I felt that was my job. And that was - that was what I was supposed to be doing every day.

NORRIS: So once you had success here at Johns Hopkins, how long before physicians elsewhere started undertaking this procedure?

Dr. WALSH: Well, it took a while because, much to my disappointment, people didn't believe me. And, you know, I was a little hurt because I've always believed I've told the truth and had high credibility. But let's think about it for a second, for 80 years, from 1904, when Hugh Hampton Young at Johns Hopkins developed radical prostatectomy, to 1982, every man was impotent.

And so along comes somebody and says he can preserve potency. I mean let's think about it, maybe, you know, maybe it isn't true. Maybe he isn't removing the whole prostate. Maybe he isn't getting out all the cancer. Maybe these men really are imagining it. Maybe Dr. Walsh is maybe not telling the full truth. And so it took a...

NORRIS: They really - they questioned your credibility to that degree?

Dr. WALSH: Of course, yes. And, you know, I think this is common. You take any new idea that's not an uncommon approach for almost anything. When something comes along that's - especially when it's somewhat revolutionary, for people to doubt it.

NORRIS: Have the two of you kept in touch over the past 25 years?

Mr. HASTINGS: Oh, yes, we have. He would send me anniversary cards saying do you realize that it's been so many years or something like that. He would always - he never failed to answer me, too, when I write to him so yeah.

Dr. WALSH: Obviously, Bob is a very special patient. He was the first patient. He is the person who is a proof of principle. But I try to keep that relationship with all my patients. There's a pile of those letters behind me on my desk. And now that I have 4,000 patients, I've a lot of patients to write to.

NORRIS: Dr. Walsh, is there something in your personal experience that led you to pursue this, someone you know who has lived with or battled through prostate cancer?

Dr. WALSH: I've got a story I'm going to tell you, which is longer than you want to hear. When I was a young boy, I had an uncle who would - who was an engineer who used to take me on hikes every Sunday, and his wife was a nurse, and he would teach me big words like the auriculo-ventricular bundle of His, and - which I then learned from her dictionary was the neuromuscular bundle between the auricle and the ventricle.

Well, when I was in urology, Uncle Harry developed prostate cancer and died a painful death. And today, in "Stedman's Dictionary" on the - under bundle on the same page where there is the auriculo-ventricular bundle of His, there is the neurovascular bundle of Walsh. So I think of Uncle Harry a lot.

NORRIS: Dr. Walsh, Mr. Hastings, thank you very much and congratulations.

Mr. HASTINGS: You're welcome.

Dr. WALSH: Thank you.

NORRIS: Dr. Patrick Walsh and his patient and friend, Robert Hastings. Today marks 25 years since Dr. Walsh operated on Hastings to remove a cancerous prostate gland using a pioneering technique that eliminated devastating side effects including impotence. Dr. Walsh's technique for treating prostate cancer is now a surgical standard around the world.

I'm Michele Norris.

BLOCK: There's the photo of Dr. Patrick Walsh and his patient, Robert Hastings, at our Web site, npr.org.

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