The decision comes to me quietly and surely, almost automatically, the tiny servo motors and fans moving and whirring inside my skull until at last the neural tumblers all line up. Click. It’s crunch time in the land of sick prostate glands and I have decided what I’ll do to get rid of the cancer that is growing in my nether reaches.

On a midsummer morning, I will rise before dawn and drive the 21 miles from my suburban home to Seattle to be laid on a table beneath a giant robot. The machine and its masters will slip tiny scalpels, cameras and other assorted devices through five holes in my abdomen to pluck Darth Prostate from my innards and cast him into the black hole where he belongs.

If all goes well, the cancer that was likely growing inside me for years will be gone — completely and forever — in about three hours. I will be walking around my hospital ward in a matter of hours and sent home in the next day or so to complete my recovery. When the catheter comes out, I’ll probably need to wear some pads in my underwear, but that shouldn’t last long. And with some work on my part, odds are even high that erections lie in my future, although they will not be the glorious boners of boyhood.

Domo arigato, Mr. Roboto!

Any man with prostate cancer has to like the simple, easy sound of that. I sure do. But choosing a laparoscopic radical prostatectomy done via the da Vinci robotic device, instead of traditional "open" surgery, which requires an eight-inch incision and a more difficult recovery, or all the other treatments available to prostate cancer patients, was anything but simple and easy.

Soon after I received my diagnosis in April, I began to dwell on two issues. First, I worried constantly that whatever treatment I chose would leave me depending on Depends and unable to have sex. Second, although I was immediately told by virtually everyone that surgery was the preferred solution for someone my age, I dreaded everything about the operation itself — the risk of infection and problems with anesthesia, having to heal from a major incision, peeing out a tube for at least 10 days.

As I pored over books, articles and Web sites about treating prostate cancer, I leaped past surgery to chapters and sections on radiation therapy. I read an entire book by a patient who had the same fears I did and underwent successful external beam radiation.

The lure of brachytherapy
The more I read, the more I liked the concept of brachytherapy, a treatment in which tiny radioactive “seeds” are implanted in the prostate in an attempt to kill it and all the cancerous cells it contains. It’s an outpatient treatment, far less invasive than surgery, and statistics indicate that it is about as good at curing cancer — at least over 10 to 12 years — as anything else.

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I especially liked the notion that, with brachytherapy, I wouldn’t have to give up most of my summer to recover from holes or a slit in my belly and sit around watching my bloody pee drip into a little plastic bag.

I began to tell friends and family that I was “90 percent sure” I was going with the seeds. Knowing that I wouldn’t have to go through the drag of surgery was a relief. I substituted worrying about that with worrying about potential issues of brachytherapy. But not much. How bad can “urge incontinence” really be? And, hey, if things were to go limp below the belt, at least that would probably happen gradually over a long time. The business of having to wait a couple of years while your PSA levels ping-pong around until they finally hit their “nadir” and you know the cure “took” wouldn’t bother me.

And then I began to think along these lines: Surely the seed treatment will give me at least 10 years without worrying about cancer. Ten years is pretty good. And they’ll be good, solid, diaper-free, sex-at-will years. I have no birthright to the average U.S. male’s life expectancy of 75.02 years. I could fall into a crevasse or die in a car wreck. I could get a completely new form of cancer. It all makes perfect sense: Since brachytherapy is as good as anything for 10 years, it’s good enough for me. And look, Ma: No surgery!

I waited for my decision to take hold and feel final enough so that I could call the hospital and schedule the next step in treatment. It didn’t. The best I could do was to make an appointment with my doctor and tell him I was “leaning toward” brachytherapy. In our chat, he told me he wanted to make it clear that even though the patient isn't cut open, radiation is “very real, very serious therapy,” not a cakewalk. He also made sure again that I understood the matter of having to wait for months to read the PSA tea leaves.

The conversation helped me realize that, amazingly, the one thing I had not focused on when mulling treatment was what I believed to be the surest method of curing the cancer. My primary motives had been to avoid surgery, pain and inconvenience, and come away with the fewest side effects.

Missing the point
Because I had heard repeatedly that all of the main treatment options have about the same outcome in curing prostate cancer, it had been easy to move on to other considerations. I had thought that was the point of being forced to choose my own treatment. But now I realized the main issue is to let the patient decide what is the best way to cure his cancer.

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I felt like I had been asleep at the wheel. All of the doctors I spoke with had made it clear that fixing the cancer should be the top priority. Now I realized why I had felt half-hearted about brachytherapy. In leaning toward it, I was “settling” for what I thought best addressed not just the chances for a cure, but also the issues of convenience and side effects. And I had been told over and over that there are “no guarantees” on side effects. Of course, there are no guarantees on curing the cancer either, whatever you choose, but stats for a case like mine almost make it seem so.

As soon as I began to re-evaluate the options, it became clear that da Vinci surgery was for me. Surgery is the only treatment that will let the doctor view the site of the cancer and do exactly what he feels is necessary to get it all out. A pathologist will be able to examine the entire prostate gland once it is removed and confirm or rejigger the original biopsy results. Some of my lymph nodes will be examined to see if the cancer has spread there. This information will be invaluable in helping my doctor and other specialists determine if additional treatment is necessary.

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