In most medical centers, the doctors’ offices are usually located near the clinic. At the James Buchanan Brady Urological Institute of Johns Hopkins, however, urologists have offices adjacent to research laboratories. The close proximity between patient care areas and research facilities helps ensure that medical discoveries are conveyed from one side to another—“from bench to bedside and back again,” explains Patrick Walsh, M.D.

As Urologist-in-Chief at the Brady Institute and Director of the Department of Urology at Hopkins, Dr. Walsh leads a center with a long tradition of major contributions in the treatment of urological disorders. The close collegial environment in which urologists work at the Brady Institute has led to important insights and techniques that benefit patients around the world.

“We have a mission of discovery,” explains Dr. Walsh. “Typically, doctors learn what is new at medical meetings, then take it home to practice. Our mission is to teach other doctors about our new discoveries at medical meetings, so that others can practice it.”   

Although the Brady Institute manages a full range of urological conditions, Dr. Walsh’s medical practice is devoted exclusively to disorders of the prostate. A walnut-size gland located at the base of the bladder, the prostate is under-appreciated for most of a man’s life. As men approach middle age, the prostate often swells—a condition known as benign prostatic hyperplasia (BPH)—until it compresses the urethra and interferes with the ability to empty the bladder.

Benign prostatic hyperplasia is one of the most ubiquitous afflictions of adult men. More than fifty percent of 70-year-old men have some degree of prostate enlargement. By age eighty, Dr. Walsh says, about twenty percent of men will require surgery or other invasive treatments to restore normal urinary function.   

Prostate cancer is a far more serious problem. The most common serious form of cancer among men, prostate cancer has an incidence second only to skin cancer. About thirteen percent of men will develop prostate cancer during their lifetime, according to Dr. Walsh’s book, The Prostate: A Guide for Men and the Women Who Love Them. An estimated 200,000 men are diagnosed with prostate cancer each year, and almost 40,000 die.

The number of new cases of prostate cancer are expected to skyrocket as the baby boomers enter middle and older ages, according to Dr. Walsh. “Over the next twenty years, the number of new cases of prostate cancer will triple, and the number of deaths will double,” he says.

These grim statistics have prompted research to find new ways of preventing prostate cancer, detecting the presence of disease early, developing better treatments for localized disease and better control of advanced disease. “We feel we have a mission to reduce deaths from prostate cancer,” says Dr. Walsh.

Nerve-Sparing Prostate Surgery
Until about fifteen years ago, surgery for prostate cancer was often devastating for the patient. The surgery invariably resulted in impotence, and caused 25-30 percent of men to suffer urinary incontinence. In 1977, a 59-year-old man reported that he was still potent after prostate cancer, an unexpected result that stunned Dr. Walsh. “I wondered why he was potent, and why everybody else can’t have the same result,” he says.

Pursuing the answer led Dr. Walsh to closely study the intricate anatomy around the prostate, and the discovery of how to remove cancerous tissue without disrupting the nerve supply to the prostate and bladder. The “nerve-sparing” technique has revolutionized prostate surgery, lifting the life sentence of impotence for many men. Dr. Walsh says that about eighty percent of his patients remain sexually potent after prostate cancer surgery, with significant incontinence affecting only two percent.

An extremely organized and fastidious surgeon, Dr. Walsh maintains a detailed database on more than 2,500 patients who have undergone prostate cancer surgery. The database contains a wealth of information about outcomes, including data on cancer control and surveys of sexual and urinary function reported by his patients. Close analysis of his results shows patterns that may elude a more cursory examination.

Dr. Walsh has videotaped his operations, using video as a golfer does to improve his swing, or a football coach to review a team’s plays. Review of the entire operative field allows him to observe nuances of the procedure, see peripheral events and interactions that aren’t always obvious at the operating table. “There are a million small steps in surgery,” he says. “The smallest variation in surgical technique might make the difference between success and failure.”

A half-dozen urologic surgeons at Hopkins perform the nerve-sparing surgery. Dr. Walsh has taught the nerve-sparing prostate surgery to urology residents who spend four years training with him. He has also described the procedure extensively in the medical literature and at numerous professional meetings. Thousands of surgeons have also been invited to observe the surgery at Hopkins.

Dr. Walsh has nearly completed work on his “magnum opus,” a three-hour video for surgeons that shows the intricacies of prostate cancer surgery. “The problem of prostate cancer goes far beyond what I can do with these hands,” he says. “If I can enunciate and illustrate exactly what I do, then many more people will be able to do it.”

Fostering Clinical Advances
The dedication to charting new pathways for patient care and sharing findings with the medical community is a common thread at Hopkins. Hopkins scientists and urologists have contributed to the early diagnosis and treatment of benign prostatic hypertrophy, prostatitis and bladder cancer. Scientists at Hopkins have also refined the measurement of prostate-specific-antigen (PSA) for the early diagnosis and assessment of prostate cancer, providing an early warning before symptoms of the disease are apparent.

At present, scientists at Hopkins are investigating new drug treatments for prostate cancer, delving into molecular genetics to look for cures. Hopkins doctors have discovered a gene that suppresses the spread of prostate cancer, and are working on a vaccine that may be effective against some advanced cases of prostate cancer. They have also identified the location of two genes for inheritable forms of the disease.

A cross-fertilization between patient care and research laboratories is essential to the continued gains in the fight against cancer and other prostate disease. “Discoveries occur at the bedside, in the laboratory, and in the operating room,” says Dr. Walsh. “We have scientists who really understand clinical urology, and surgeons who really understand science.” For more information or a physician referral, please call the Brady Urological Institute at (410) 955-6707.