Iam 66 years old. 8 years ago, during a routine checkup, my doctor did a digital rectal examination and discovered that something was wrong with my prostate. He suggested that I go and see a urologist. During the previous year, I had already visited a urologist on 13 occasions because of steadily increasing difficulties with urination. On this occasion, because of the extreme pain I was in, I asked to be refered to, and saw, a specialist who was also a surgeon. The urologist that I was sent to see measured the amount of prostate specific antigen (PSA) in my blood, and then did a prostate biopsy. The results were devastating; I had cancer. Without being given the chance to seek a second opinion, I was scheduled for a radical prostatectomy. After the operation I spent 4 weeks in hospital because of complications that were never explained to me. 6 months after the operation my PSA values began to rise again, and I was given drugs to stop my body from producing testosterone. A year later I needed a bilateral breast reduction because of the sideeffects of my medication. I was given another agent to try, but that also had extensive side-effects. But that was all a long time ago, today I am no longer frightened or horrified by the idea of dying from cancer, and am once again a happy and optimistic person (figure). I no longer contemplate suicide as I did during the worst of my persistent incontinence after the operation. Nor do I equate my impotence, another adverse effect of prostatectomy, with the loss of my masculinity—though I once did. Today, I am able to live with cancer and to handle the disease. 3 years ago, I set up a prostate cancer support group in Munich, Germany. There are about 100 members and we meet once a month. We work with clinics and doctors, and talk as a group about our cancers and the available treatments. We lean on each other and, importantly, persuade patients diagnosed with prostate cancer of the benefits of talking to their loved ones, friends, and other affected individuals who share the sickness and a similar fate. Today, my knowledge about prostate cancer and the diverse therapies and their side-effects is much greater than it was when I was diagnosed. Concurrently, my knowledge about the shortcomings of the medical profession has increased. I could tell some terrifying stories about what goes on in some clinics, and I can honestly say that there is never enough information available, either in the form of literature or from the doctor, to help patients to make the right choice about treatment; a situation that fills me with such despair that I feel like screaming and shouting at those responsible. I often spend hours on the phone with newly diagnosed men, few of whom know much about the treatment options that their doctors have suggested—ie, radical prostatectomy. Importantly, doctors often neglect to tell their patients about the posibility of postoperative incontinence and impotence, and about possible residual cancer needing hormone or radiation treatment, or both. Furthermore, patients are rarely informed about alternative treatments that are available, such as seed implant, proton or neutron radiation, high-intensity ultrasound, three-dimensional conformal radiation therapy, cryosurgery, or the possible benefits of hormone treatment before surgery. I have even heard of patients with prostate cancer who were clinically diagnosed with thyroid tumours, and who were operated on before it was known whether or not their cancer had metastasised. And in another case, one doctor ordered a certain treatment, which was subsequently changed by another doctor, who felt that it was too expensive. In my opinion, there are too many radical prostatectomies done in Germany, especially when compared with other countries. Perhaps the rate is so high because of a lack of reliable statistics about the severity of prostate cancer and the actual numbers of patients, or maybe because there is not enough information about which treatments are successful and which are not. More information is also needed about clinics and specialists in the field. That said, some doctors do welcome informed patients and are open to new treatment approaches. Some even talk to their patients and answer questions. These individuals give me hope, and are the reason why I dedicate my time and energies to the prostate cancer support group. I hope to increase awareness of prostate cancer so that other men might see their urologists in time for an early diagnosis and favourable prognosis. Siegfried Gebhard, South Africa (May, 2001)