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    'You've Got Prostate Cancer'

    An American man has a 1 in 5 lifetime chance of hearing those 4 words. What he will do about them is a decision that will affect the rest of his life.

    Hormonal Therapy continued...

    What's good about hormonal therapy is that it can greatly improve the outcomes of other treatments, particularly in the later stages of disease. When used alone, it can keep a cancer in check for many years, although it does not cure it.

    The downside is that sexual function and sexual desire can be lost. While orchiectomy has the disadvantage of being permanent, chemical castration has the disadvantage of cost. In both cases, there may be hot flashes and a variety of other side effects.

    Cryotherapy kills prostate tumors by freezing them. It can also freeze the urethra, the tube that carries urine and semen. However, new techniques to warm the urethra have led to new interest in this technique. Despite these advances, most doctors still consider cryotherapy experimental.

    The good thing about cryotherapy is that it is minimally invasive and requires only a one-day hospital stay. There is almost no bleeding, and the risk of urinary incontinence is very low. Patients treated with this technique can still choose other treatment options in the future.

    The downside is that nobody knows the long-term effectiveness of this treatment. About two-thirds of men treated with this technique become impotent. Patients who choose this option should find a doctor who has a lot of experience using this technique.

    So What Do I Do?

    Treatment of prostate cancer has two goals, says Mark S. Litwin, MD, MPH, a urologist at UCLA Jonsson Cancer Center. These goals are survival, and preserving -- or even improving -- the quality of a person's life.

    "Dying of prostate cancer takes a long time compared to other cancers -- so the effects of treatment remain with a man for a very, very long time. This is the human cost of prostate cancer," Litwin says. "Health is not merely absence of disease, but a state of complete physical, emotional, and social well-being. To me that means we have to go about task of [considering] these different components."

    More than for any other disease, the choice of treatment for early-stage prostate cancer depends on the person making the choice. It's not a choice your doctor can make for you. So there are questions every patient must ask himself: Which treatment has the best chance of success? Which side effects of treatment would bother me the most? Which would bother me the least?

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