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A selection from
Dr. Patrick Walsh's Guide to Surviving Prostate Cancer
by Patrick C. Walsh, M.D., and Janet Farrar Worthington
page 210
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these nerves had become clear. But how could we apply our findings
in stillborn infants (which are easier to see for many reasons,
including the fact that infants have less fatty fibrous tissue than
adults) and find these tiny, microscopic structures in the deep, complicated recesses of the pelvis in adult men? It was like having a
schematic drawing, and trying to identify a burned-out transistor in
your television set. During this year, I had noticed something important: There was a cluster of arteries and veins that traveled along the
edge of the prostate in the exact location where these nerves were
found in the infant cadaver. Perhaps these blood vessels acted as they
do elsewhere in the body - maybe they provided a scaffolding for
these microscopic nerves. And maybe we could use these bundles as
landmarks. Donker agreed. I returned to Baltimore and tested this
theory while performing an operation called a radical cystectomy,
removal of the prostate and bladder, in a sixty-seven-year-old man. I
had never seen or heard of a patient who had been potent after this
operation. But ten days after surgery, this man stated that he awoke in
the morning with a normal erection.
A month later, on April 26,1982,1 performed the first purposeful
nerve-sparing radical prostatectomy on a fifty-two-year-old professor
of psychology. This man regained his sexual function within a year,
and has remained complication-free - and cancer-free - ever since.
Better understanding of the anatomical terrain also led to several important observations. Now that we've learned exactly where
the scalpel can and cannot go, depending on the extent of a man's
cancer, it has become possible either to save these nerves deliberately. or to remove more tissue by cutting these bundles away - in
surgical terms, to create "wider margins of excision" - than we previously had believed possible. It used to be that surgeons never
excised these nerves, because they were adherent to the rectum;
instead, surgeons just cut the nerves and unknowingly left them in
place. However, with these anatomical techniques, we now have a
better chance of removing all the cancer. Many people call this a
"nerve-sparing" operation, but a more accurate description is that
it's an "anatomic radical prostatectomy," because there are actually
two things going on here: one is preserving the nerves; the other is
creating wider margins - by excising them when necessary,
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