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cover of Walsh's book

A selection from
Dr. Patrick Walsh's Guide to Surviving Prostate Cancer
by Patrick C. Walsh, M.D., and Janet Farrar Worthington

page 207

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more prone to side effects after surgery than younger men, and you must consider the quality of the years added to your life. How would you feel if you never regained full control over urination? Also, what if you had complications and were not cured -- remember, from Chapter 7, that older men often have more advanced disease, because it has been there longer. On the other hand, if you select a less effective form of treatment, have a long life, and your cancer comes back, you may end up asking yourself "what if" -- what if you had gone for the best treatment the first time around? For older men, this can be a tough decision.

Today, radical prostatectomy cures the vast majority of men with cancer confined to the prostate, even if it has penetrated the wall, or capsule, of the prostate. And preserving potency -- by not removing one or both of the nerve bundles adjacent to the prostate, which are responsible for erection (surgeons didn't even realize these bundles existed two decades ago) -- does not compromise cancer cure; a recent study found that the odds of cure are just as high. Today, serious bleeding is very rare, and if the operation is performed by an experienced surgeon, preserving potency is common, and few suffer from serious incontinence.

Evolution of an Operation

Surgery to remove the prostate as a treatment for cancer was first performed in 1904, at Johns Hopkins by a urologist named Hugh Hampton Young. Young's procedure, called a radical perineal prostatectomy, was a success: Six and a half years later, when the patient died of other causes, an autopsy showed that his prostate cancer had been cured.

In the late 1940s, another approach called the radical retropubic prostatectomy was developed, and like Young's operation (which still is used today, although not as often as the retropubic approach), it proved extremely effective in stopping prostate cancer in its tracks - if, that is, the cancer was confined to the prostate.

Both the radical perineal and retropubic operations had a definite downside -- two devastating side effects, incontinence and impotence. Every man who had a radical prostatectomy was impotent, and as many as 25 percent had severe problems with urinary control. Worse was the extreme, often life-threatening bleeding that went along with

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