THE LONDON PROSTATE CANCER CENTRE NEWSLETTER | SPRING 2012 AN with INTERVIEW Dr. Patrick Walsh I recently had the privilege to talk with Dr. Patrick Walsh the Distinguished Service Professor of Urology at the Brady Urolological Institute of the Johns Hopkins Medical Institutions in Baltimore, Maryland. Dr. Walsh was honoured as the 2007 National Physician of the Year for Clinical Excellence by America’s Top Doctors. Q. As a prostate cancer patient, I have to tell you that I regard your book “Surviving Prostate Cancer” as the most thorough and easily understood publication on prostate cancer for men and their families. I understand you are considered the world’s foremost authority on prostate cancer. How did you become such a distinguished surgeon? A. I have devoted my entire life to reducing death and suffering from prostate cancer in men around the world. Q. Prostate Cancer is such a prevalent disease in men, what advice would you give to the male population? A. Nothing about the prostate is easy, so man’s best protection against the disease is to have it detected early. The first prostate checkup should establish a baseline and we suggest doing this at age 40, before men develop benign enlargement of the prostate. This establishes the risk of having problems down the line and dictates how often PSA should be measured in the future. Until recently, we used to recommend this only for men at higher risk but research at Johns Hopkins has led us to believe age Dr. Patrick Walsh forty is the best place to start. Q. Can you give me an example of how this baseline would work? A. Yes. We are talking about risk assessment here, not screening. Let’s say your PSA is 0.6 when first measured. Any consistent change of 0.4 per year could indicate you are at risk and require further consultation. Q. Recently there has been a lot of talk about prevention, particularly chemoprevention (use of certain drugs). Would you comment on that? A. There is no pill a man can take that will reduce his chances of developing prostate cancer. This includes vitamin E, selenium and drugs in the class of 5 alpha reductase inhibitors (finasteride & dutasteride). The FDA in the USA has informed physicians that these drugs are not safe for use in the prevention of prostate cancer because they increase the risk for the development of high grade disease. Q. I understand it was only in the and John Hastie. early eighties that you discovered and perfected the nerve sparing technique used in radical prostatectomies to maintain potency. Given your vast knowledge and expertise what do you look for in a surgeon? A. You are looking for the one surgeon who will perform the one radical prostatectomy you will ever receive in your life, the one operation that will cure your cancer. You will want to know: How many of these operations does he do in a year? (ideally hundreds) Does he know and use nerve sparing techniques? Does he keep up with the latest research? Does he screen his patients? You will want to find a surgeon who does this operation often, preferably several days a week. Thank you, Dr. Walsh, for the opportunity to publish this short interview in our Prostate Cancer Centre newsletter. • Interview conducted by John Hastie, Editorial Board.