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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 211
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removing as much tissue as possible around the cancer - making
this a better cancer operation.
At the same time these discoveries were taking place, an
anatomist provided an entirely new insight into the location of the
sphincter responsible for urinary control. Previously, we believed
that the pelvic floor muscles opened and closed like sliding doors.
But this was not the case; it turns out that the sphincter is a tubular
structure, embedded in the veins that had once bled so much during
surgery. This observation explains why the anatomic approach
improved the results of urinary continence: In controlling the
venous bleeders, and making the "bloodless field," we did a better job
of preserving this sphincter.
Today at Johns Hopkins (the hospital is noted here because
results vary worldwide, depending on a range of factors, including
the surgeons' skill and the selection criteria for patients), 86 percent
of men who undergo surgery are potent, only 2 percent wear a pad
that they change more than once a day, and the cancer control rates
are used as the "gold standard," to which all other forms of treatment
are compared.
Overall, in men treated since 1989, at ten years or more after surgery, only 2 percent have developed local recurrence of cancer and
only 8 percent distant metastases; and 80 percent have an undetectable level of PSA. (For more on cancer control, see Chapter 10.)
Important determinants in the return of sexual function include age,
the extent to which the cancer extends outside the prostate, and the
extent of nerve loss - whether one or both nerve bundles remain, or
whether they had to be removed during surgery.
We tell our patients that we have three goals: removing all of the
tumor, preserving urinary control, and preserving sexual function.
Sexual function is number three, because if it is lost there are many ways
to restore it.
Men who are impotent following radical prostatectomy have
normal sensation, normal sex drive and can achieve a normal orgasm.
The one element they may be lacking is the ability to have an erection
sufficient for intercourse, and that can be restored by drugs such as
Viagra, or by other means. (For more on erectile dysfunction, see
Chapter 11.)
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