For most men, avoiding a radical prostatectomy in favor of radiation therapy was an easy decision, given the risks of such debilitating surgery. Only seven percent of sufferers opted for it. But today, more than a third of those eligible for the procedure undergo it, most surviving with both erectile function and urinary control intact. Yet long before this standard-of-care turned the tables on side effects, other surgeons would lay the groundwork. Vienna's Billroth boldly ventured into unknown territory when attempting the first radical perineal prostatectomy for cancer in 1867, entering through an incision in the perineum, between the rectum and scrotum.
But it was Johns Hopkins' Young—the "Father of American Urology"—who gave this approach staying power. Moved by his success with his perineal prostatectomy in treating patients with benign prostatic hyperplasia, Young leapt at the possibility that cancer could be cured if he extracted the entire prostate and its capsule, studied the prostate's anatomy and designed a surgical plan.