Seed plus beam radiation Surgery plus beam radiation

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pay a portion of the bill, and the more expensive the physician you select, the higher your portion of the bill is likely to be. Managed-care companies also restrict your options. One study found that Health Maintenance Organizations (HMOs) were more likely to have men treated by radiation than by surgery, since radiation entails lower hospitalization costs.30

For men under the age of 65 who do not have health insurance, Medicaid is the best means of coverage. Qualifications differ widely by state. Medicaid coverage is roughly similar to that of Medicare, and you must use physicians who accept Medicaid, which many do not. A useful analysis of payment systems for covering prostate cancer treatment can be found in Prostate Cancer: A Survivor's Guide, by Don Kaltenbach and Tim Richards (Seneca House Press, 2003).

Once these ten factors have been considered, many men look for a definitive treatment trial to tell them what to do. Unfortunately, the definitive treatment trial is a myth. Because the treatment of prostate cancer is constantly changing and because prostate cancer progresses so slowly, the information provided by most treatment trials is out of date by the time it becomes available. In my case, I wished that twenty years ago researchers had started a comparison of surgical versus beam radiation treatment so that I would know the long-term outcomes regarding death rate, side effects, and the like. Of course, such a comparison is never going to happen, because the treatment technology for prostate cancer is a moving target. Many comparative treatment trials have been started in recent years, but the results will not be known for fifteen or twenty years. By that time surgical and radiological techniques will have evolved, combinations of treatment will be routinely used, and additional treatment options will be available. And at that time, we will wish that comparative treatment trials had been started now, using the technology of the future.

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