At 18 or more months after the surgery, 59.9 percent of the patients said they were impotent and 8.4 percent reported being incontinent. However, 71.5 percent also said they would make the same treatment choice again.

At 24 months after surgery, 41.9 percent of the men reported that sexual function was a moderate-to-big problem and 8.7 percent reported being bothered by a lack of urinary control. Urinary function varied by age, and sexual function varied by both age and race, according to the study.

"Our study suggests that radical prostatectomy is associated with significant erectile dysfunction [impotence] and some decline in urinary function," the authors concluded. "These results may be particularly helpful to community-based physicians and their patients with prostate cancer who face difficult treatment decisions."

The study's findings underscore the American Cancer Society's (ACS) emphasis on informed decision-making. The ACS advises patients to be well aware of treatment options and the side effects associated with each treatment.

Before undergoing prostate surgery, you should learn all you can about the benefits, risks, and side effects of the operation. Following are some questions to ask your doctor:

• Why do you recommend this operation? What are the chances of its success?
• What is the likelihood my cancer has spread beyond my prostate? If so, is it still curable by surgery?
• Are there any other ways to treat this cancer? Compared to surgery, what is their likely impact on my survival, risk of side effects, risk of complications, and quality of life?
• How many operations like the one you are suggesting have you done?
• Will you attempt to do a nerve-sparing procedure?
• Exactly what will you be doing – and removing – in this operation? Why?
• How long will the surgery take?
• What can I expect after the operation? Will I be in a great deal of pain? How long will I be in the hospital after the surgery?
• How long will it take for me to recover? Will any of the effects be permanent?
• What will happen if I choose not to have the operation?

Men facing difficult decisions about localized prostate cancer treatment often find it helpful to see one doctor specializing in urology and another in radiation oncology to get information about the pros and cons of both prostatectomy and radiotherapy. Other surgical procedures, such as cryosurgery, may be a good option for some men. A man's primary care doctor is often helpful in explaining and weighing the options proposed by various specialists.

The ACS estimates 180,400 new cases of prostate cancer will be diagnosed in the US this year, and an estimated 31,900 men are expected to die from the disease during 2000. Prostate cancer is the second leading cause of cancer death in men.