size of a grain of rice, via a thin needle
throughout the prostate. The seeds
give off radiation for several weeks and
remain in place after the radioactive
material has been released.
An alternative to permanent seed
implants is high-dose brachytherapy:
doctors use needles to place small catheters in the prostate. The catheters are
then filled with radiation—at higher
levels than you’d get with typical seed
therapy—and left in the prostate for 5 to
15 minutes before removal. The patient
usually gets three treatments over a couple of days. High-dose brachytherapy
is typically combined with a course of
low-dose external beam radiation.
The risks of brachytherapy are
similar to those for external beam
radiation. About 5 percent of men
develop significant and persistent
rectal problems, and about 30 percent
of men experience urinary frequency.
The risk of impotence is slightly lower
than with external beam radiation.
Hormone therapy • Also called
androgen deprivation therapy, this
blocks the effects of male hormones
that can cause prostate cancer cells to
grow. Unlike other treatments, hormone therapy is not considered curative, but it may help shrink a tumor or
slow its growth, and it is most often
used in conjunction with surgery or
radiation.
For all of these procedures, finding an experienced and skilled
physician is just as important as
choosing a treatment. “The choice
of doctor may actually trump the
choice of treatment,” Litwin says.
He and Torrey suggest asking friends
and family for referrals, and then
interviewing each physician. For
surgeons, ask about the number of
operations they’ve performed, and
ask if they track their own outcomes.
(You can also check to see whether a physician has been disciplined
through your state’s medical board.)
No matter which treatment you
choose, most men continue to enjoy
the same activities they always did.
University of Texas surgeon Thompson has observed that prostate cancer
sometimes serves as a wake-up call,
prompting men to make lifestyle
changes—losing weight, quitting
smoking—that enable them, after
their diagnosis, to enjoy better health
than they had before.
Sometimes, though, the changes are
more subtle. For Torrey, who chose
radical prostatectomy, prostate cancer
changed the way he thought about his
relationships, including his relationship with time.
“It gives you a lovely reason for not
doing things that other people think
you should do,” he says, “and for spending time the way you really want to.” ;
Jay Griffin is a freelance health writer in
Mountain View, California.
