A guy's toughest choice

My research and conversations with prostate cancer survivors convince me that the risk of bad incontinence from either surgery or radiation is not huge. Porter says his results are in the high 90 percent range for men to be free of any serious issues — and protective undergarments — a year after surgery. All of the surgery patients with whom I have spoken, save one, agree.

Potency is a whole other story. Not too many years ago, impotence was an accepted cost of all prostate surgery. But in the ’80s, surgeons found the nerves that control Mr. Happy and perfected “nerve-sparing surgery” to save them. This is the procedure Porter uses. He believes that three-quarters of patients my age or younger who have surgery at his hospital regain satisfactory potency within a couple years. While he believes that half of all radiation patients eventually become impotent, he cannot separate the stats by age. His radiation colleagues believe that for a guy my age the impotency risk with radioactive seeds is considerably less but can’t cite any definitive studies.

One reason that it’s harder to track the differences between surgery and radiation is that if surgery ends your ability to achieve an erection, it happens immediately. With radiation, it can take two to three years.

I leave Porter’s office nowhere near ready to make a choice. I feel like there is only one right decision and if I blow it, I'll regret it for the rest of my life. The electrical storm crackles and pops.

I split from my wife of 23 years not too long ago and now am in a fairly new relationship. This has been a very difficult time for my girlfriend, too; studies show that the emotional toll of prostate cancer is frequently higher for the patient's partner than for the patient himself.

Would you rather...?
The sex issue is heaviest on my mind. Once again, I find myself feeling a bit ashamed for dwelling on it so much. Strong advice from Dr. Ksenija Stefanovic, one of Porter's urologist colleagues who will advise and treat me for any sexual complications, is not to base my treatment decision on my hopes for the best outcome in bed.

First and foremost, take your best shot at curing the cancer, she counsels. When it comes to sex problems, "there are no guarantees" with any of the choices but there are many ways to try to solve them.

Still, I feel like my treatment options have become a bizarre revenge for all those drunken hypothetical debates I joined as a young man around the campfire: Rather be blind or confined to a wheelchair? Deaf or lose your sense of taste? Live longer and screw less, or vice-versa?

I can’t say that my anxiety over this issue is a conscious fear of losing my “manhood.” I don’t think I like sex so much because it makes me feel powerful and manly. I can always take up weight-lifting or buy an F-350 with a Powerstroke diesel. I think I like sex so much because I just like sex so much. I like it like I like seeing, walking, hearing, tasting and breathing.

Test yourself What's your risk for prostate cancer?

Yes, there’s fun and intimacy to be had in bed without erections. But when talk turns to sex among women, I’ve heard that while debate can get fast and furious over whether size matters, there’s never any argument over hard vs. soft. The talk of all the new remedies for erectile dysfunction rings as hollow as the promise of crutches to a prospective amputee.

On a hopeful note, some couples insist that the whole experience of sex without erections is just as satisfying as with them, if quite different. But my own hopeful note is that I don’t have to find out.

MSNBC.com writer Mike Stuckey was diagnosed with prostate cancer in April. He will chronicle his battle in "Low Blow," a series appearing every other Wednesday. In the next installment, Mike chooses a treatment.                                                                      

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