Mapping Nerves

Then Walsh came along and traced the erectile nerves in stillborn fetuses, in which the nerves are easier to see. He also figured out how to tie off veins that lie along the prostate, limiting blood loss. In March 1982, he removed the bladder and prostate from a 67-year-old man with bladder cancer. Walsh had never seen a patient remain potent after the procedure. This man got an erection 10 days later.

Since then, Walsh has done 4,000 nerve-sparing prostatectomies. He says he's never been bored. ``There is much more variability to the male anatomy than there is to every golf course in the world,'' Walsh says. A prostatectomy is major surgery and often runs five hours or more.

Halfway through Bigg's operation, Catalona called Melissa Bigg and told her things looked good. Bigg's cancer hadn't spread. For the first time in months, she felt relieved.

Not Like 16

Bigg was discharged from the hospital that Wednesday. He wore a catheter for a week while his urethra, which has to be cut, healed. He took a month off from work to recuperate. For the first three months after his surgery, Bigg leaked urine when he screamed on the trading floor. Since then, he's had no problems, he says.

Bigg and his wife say the surgery hasn't diminished their sex life. ``Erections aren't what they were like when I was 16, but they weren't anyway,'' Bigg says.

``I have no complaints,'' Melissa Bigg says.

Men whose cancer is less dangerous than Bigg's must grapple with conflicting opinions and weigh the potential risks and benefits of various treatments.

When Weinstein, the former hedge fund manager, was diagnosed 10 years ago, his Gleason score was a moderate 6: 3 + 3. He concluded that his cancer didn't pose an immediate threat to his life. Divorced and interested in a new relationship, he didn't want to risk impotence.

Hospital Visits

Weinstein set out to learn as much as he could. He had the resources: After working as a managing partner at Montgomery Securities, the San Francisco brokerage that's now part of Bank of America Corp., he became a financial adviser to the billionaire Pritzker family, which controls the Hyatt hotel chain. These days, Weinstein splits his time between San Francisco and Honolulu.

``I drove people crazy,'' Weinstein says. ``I spent seven months on the phone and on planes.'' He still has the rainbow of colored ID cards from all the hospitals he visited.

Weinstein says some of the surgeons he talked to didn't impress him. In a 79-page account of his experience that he shares with men who call for advice, he says one doctor talked to him on the phone for all of 15 minutes before recommending surgery.

Weinstein spoke to Intel's Grove, who chose to treat his cancer by having radioactive seeds injected temporarily in his prostate. Weinstein says Grove told him that the survival statistics were skewed in favor of surgery because men whose cancer had breached the prostate -- harder cases, in general -- often ended up being treated with radiation.

Clueless Docs

Weinstein's conclusion, after visiting 30 doctors in the U.S. and corresponding with 14 abroad: ``There are 8,500 urologists in the U.S., and 8,200 don't have the faintest idea what they're talking about.''

Weinstein opted for permanent radioactive seeds. The seeds are actually titanium capsules the size of rice grains, with bits of radioactive iodine, palladium or cesium inside.

Radiologists image the prostate with ultrasound and then use a computer to figure out how many seeds they need to radiate the gland. As many as 150 are implanted, says Dr. Peter Grimm, co- founder of the Seattle Prostate Institute. They're placed through a needle inserted near the scrotum.

The advantage of seeds, Grimm says, is that patients are on their feet the next day. Continence isn't a problem because the internal urinary sphincter -- one of two sphincters that control urination -- isn't removed, as it is in surgery. Urination can be frequent or urgent for a few months, but then it returns to normal.

No Magic Bullet

What's more, 80 percent to 90 percent of patients who choose seeds are usually able to have sex afterward, Grimm says. Their erections are unlikely to be as good as they had been before. ``There's nothing perfect,'' Grimm, 54, says.

Grimm and his partners were among the first to use seeds, in 1986. One of their early patients was Grimm's father, Huber, in 1988. He had a Gleason grade of 6 and a palpable tumor. Almost 20 years later, Grimm's dad is still cancer free.

One of Grimm's partners, Dr. John Blasko, treated Weinstein. Everything went smoothly, Weinstein says. When a friend -- the funniest person he knows -- showed up afterward and started cracking jokes, Weinstein laughed so hard that one of the seeds dislodged and passed out in his urine. He found it in a screen used to catch such errant seeds and put it in a special radiation-proof capsule that Dr. Blasko had given him.

Weinstein says urination was painful and urgent for about six months. During that time, he traveled by private jet, rather than on commercial airlines, on business trips because he was afraid he'd get stuck waiting to use the toilet. He'd tell his limo driver to take back roads so he could stop to relieve himself.

Pit Stop

One time, in Sonoma County, California, he asked to use the bathroom in a convenience store. When the owner refused, Weinstein walked out and urinated on the side of the building. Today, Weinstein says he's cancer free, potent and continent.

Hurley had seen prostate cancer kill his father and ravage two brothers, and he knew he didn't want to go through surgery. When his time came, Hurley, 53, says an operation seemed extreme. Hurley is 6 feet, wiry and, he says with a laugh, happily divorced. He says he wasn't ready to risk surgery and not being able to have sex.

``Ripping it out of my stomach seemed like a radical thing to do,'' he says. ``It's like blowing up a mosquito with a stick of dynamite.''

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