Giuliani's cancer was apparently caught in its early stages, thanks to a PSA blood test that often signals prostate abnormalities. But like other men caught in a similar bind, Giuliani must choose from several different courses of treatment, each with decided advantages and disadvantages. The most conservative choice is surgical removal of the walnut-size gland, but this comes at great risk of losing sexual function or becoming incontinent. Radiation treatment, the second major option, may be as effective as surgery and is often used in combination with it. It's delivered by high-energy beams that zap the prostate or by radioactive pellets the size of rice grains implanted in the prostate.
Radiation carries risks similar to surgery in terms of incontinence and impotence.
It's also unlikely that Giuliani will choose hormonal therapy, which prevents the male hormones from stimulating further prostate growth. It can be used together with other therapies, but it's more common when the cancer has spread. After his father died of prostate cancer at age 73, Giuliani started his screening early, a practice recommended for any man with a family history of the disease. But as effective as the test is at detecting the cancer in its early stages, it isn't perfect. When I was late for school, my mother liked to say the early bird catches the worm.