Contents

Acknowledgments xi Abbreviations xiii

1 On Being Diagnosed 1

2 How Serious Is Your Cancer? 11 What Is Your PSA? 12

Is Your Cancer Palpable? 15 What Is Your Gleason Score? 18 Additional Predictors of Severity 24

3 Surgical Treatment 27

Who Are Good Candidates? 28 The Procedure 29 Complications 39 Outcome 42

4 Radiation Treatment 46

Who Are Good Candidates? 48 The Procedure 51

• Beam Radiation 54 Complications 55 Outcome 59

5 Hormone Treatment 67

Who Are Good Candidates? 68 The Procedure 69 Complications 72 Outcome 76

6 Cryotherapy 78

Who Are Good Candidates? 78 The Procedure 79 Complications 79 Outcome 80

7 Alternative and Experimental Therapies 81

Herbal Therapies 82 PC-SPES: A Cautionary Tale 85 Experimental Treatments 87

8 Treatment Decisions 89 Watchful Waiting 90

Ten Factors to Consider 95

Advantages and Disadvantages of Treatment Options 110 How I Made My Decisions 115

9 Your Support System 118 Yourself 118

Family and Friends 124

Coworkers and Business Colleagues 128

Support Groups 130

10 Major Complications and Their Treatment 132

Urinary Incontinence: The Problem 133 Urinary Incontinence: The Solutions 135 Impotence: The Problem 140 Impotence: The Solutions 144

11 What Happens if the Cancer Spreads or Comes Back? 152 Will It Kill Me, and if So, When? 153

Treatment Options for Recurrent Cancer 159 Weighing Quantity versus Quality of Life 164

12 What Is Known About the Causes? 169 Clues 169

Genes 175

Viruses and Other Infectious Agents 177

Sexual Activity 178

Hormones 180

Dietary Factors 181

Other Possibilities 183

Summary of Causes 185

13 Factors That May Prevent Emergence or Recurrence 187 Dietary Factors 188

Vitamins and Minerals 194 Medications 195 Lifestyle Changes 197 So What Should You Do? 198

14 Science and Politics 199

The National Cancer Institute 200 The Prostate Cancer Research Program 201 Michael Milken's Prostate Cancer Foundation 202 The National Prostate Cancer Coalition 204 Other Players 205

15 Advice for Men Who Do Not Have Prostate Cancer 208 Should I Be Tested? 208

Biopsies 212

Ten Recommendations 214

Future Research 216

Appendix A The Anatomy and Function of the Prostate Gland 219 Appendix B Evaluation of Books About Prostate Cancer 224 Appendix C Useful Websites on Prostate Cancer 235 Notes 241 Index 267

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