He has been receiving external beam treatment. … And I am of child-bearing age … And we are interested in conceiving.

—–

Amy responded as follows:

Dear PG:

Then I really think the wisest thing to do is talk to the radiation oncologist and get an expert opinion. It has to be wiser than mine!

Amy

My husband has been receiving radiation treatment for a few months now for prostate cancer. I am wondering if it is safe for us to have unprotected sex, i.e. is his semen radioactive and would that have an effect on me? We have been taking precautions but I would prefer not to if not neccessary.

Thank you

—–

Amy responded as follows:

Dear PG:

Please understand that I am not a clinician, just a reasonably well informed lay person.

Having said that, I am not aware that external beam radiation of the prostate is associated with any risk for the transmission of radiation to a partner. (The situation with brachytherapy — the implantation of small radioactive seeds — is slightly different; see below.)

The best thing to do would be for you and your husband to check on this with his radiation oncologist to be on the safe side. The greatest risk would likely be if you were still of child-bearing age, in which case it might well be wise to avoid pregnancy while your husband is receiving radiation therapy. However, if pregnancy is no longer an issue, then it may well be perfectly OK to dispense with the precautions you have been taking.

As I said above … best to check in with your husband’s doctor.

If your husband’s radiation therapy is being given by the use of brachytherapy, then the risk is that he might ejaculate a radioactive seed that had become dislodged from his prostate into your vagina. This is definitely not something you want to have happen, even though the risk of serious consequences is small. So if he has been treated with brachytherapy, you and your husband should ask his radiation oncologist exactly how long you need to continue with the use of condoms and any other recommended precuations. It would depend on exactly what type of radioactive seeds had been used.

Hope this is helpful.

Amy

I think my husband has prostate cancer but won’t tell me. All the signs are there. I know he has it but I don’t want to let him know I know. It’s killing me inside.

I have known for a while now. For up to 3 weeks he hasn’t wanted to have sex, and he turns me completely away. It is so cold in the bedroom. He just lies down and go to sleep or look at TV

Don’t get me wrong. I went through thinking it was another woman, but I don’t think so. I don’t know how to talk to him. All I do is cry and cry and cry some more.

Help … please.

—–

Amy responded as follows:

Dear Carolyn:

There are many possible reasons why your husband is behaving the way he is, and I don’t think we should be assuming it is prostate cancer. However, what we can assume is that there is something that is very much on his mind and that it needs to be talked about. Just as an example, maybe he has been told he is going to lose his job (or has already lost his job) and he has no idea how to tell you.

What is important here is that you need to find a way to talk to him about the problem … whatever it is. You both know there is one, and until you can talk about it, it is like an emotional monster that is hanging over everything. Your husband may be as upset about whatever is going on as you are.

I really don’t know what else to tell you except that you need to be able to talk about the problem with him. You know him. I don’t. Is there a way to make a joke out of the question? (“Have I turned into a pumpkin? We had a great sex life until two weeks ago?”) Can you just ask him directly? (“What’s going on? Have you lost interest in sex?”)

Somehow you have to be able to get the problem out on the table. It may be something completely unexpected.

Hope this helps.

Amy

I was cringing as I began to read your letter, I was literally afraid to read it, because I totally expected you to come down hard on me for all these selfish things I’ve been feeling. I fully realize how selfish they are. So I was expecting that. I’m so relieved that I can read your response and not feel taken to task, as I already take myself quite to task under everything else. I truly have no one to talk to about this, so please understand how much I genuinely appreciate that you were so kind to me. Thank you, so, so much. I really cried when I read your response, everything’s been pent up for so long. I keep crying but I do feel better, just having someone to talk to about this who isn’t judgmental means so much.

Because I do realize that what I’m going through is a pale silhouette compared to what my poor husband is going through. He was an incredibly handsome, accomplished, virile man (and is still incredibly handsome and accomplished), and sex was always very special for him, and with him. It was a major part of his self-image, as I am sure it is for most men. Right before the surgery we talked about the possibility that the outcome would be the end of our sex life as we had known it, and at that time I told him truthfully and honestly that if that was what had to be, I felt that I could be fine with that, and that I felt completely lucky to have lived in the sunshine of his attention and to have been his partner in what was for me sacred sex for 30 wonderful years; I said too that we had probably had more wonderful sex at that point that the majority of people on this earth ever had in their entire lives, and that I was absolutely 100 percent for him no matter what. And that was, and remains, absolutely true.

We had witnessed his brother-in-law die a horrible death from prostate cancer about 10 years ago, an event which pretty much seared itself on our consciousness — and I think we were both really freaking out that the same fate might be looming over my husband. But we were freaking out only separately — when together, we were very strong and calm for each other.

So when my husband discovered this doctor through his urologist, and read recommendations about him online, and liked him a lot when he went for his first examinations, I think the knowledge of what happened to our brother-in-law propelled my husband headlong toward the quickest solution possible. But as I said, the thought that it didn’t have to be that way if he would have listened to me is the thing that torments me. The realization that he cut me out of the decision as to what he should do, what doctor he should chose and the unnecessary irrevocableness of the result has proven to be hard to live with.

It almost seems like it makes those 30 years of what I thought was perfect understanding and rapport between us a lie. I guess that’s the collision with reality I’m having that is shaking me up, that what I’ve believed about our marriage all these years was a lie, this perfect understanding. He ignored my every standpoint, with disaster as the result. This has rocked my reality and I can’t seem to get my bearings. I don’t know what to do. I feel so confused and lost. And lonely. I flat out cannot talk to him about it. I really could never forgive myself if I blurted these unutterable things like “Why didn’t you listen to me!” “Look what you’ve done!” which would be nothing but destructive, and after he’s been so hurt. I just couldn’t live with that, if I ever said anything to him like that. That would be unforgivable. That really would be the end.

I did compose a few different letters (so far) to the doctor, written in varying proportions of understanding and rage. I haven’t mailed any of them because ultimately what good will it do? Maybe it might make him ponder a little more the repercussions of his decisions in the OR, but realistically, if that guy isn’t aware of that at this point in his career I don’t know how anything I could say could enlighten him further. Having our experience published here, which might allow some other couple to think a bit more deeply about the ramifications of their decisions, to perhaps give the husband some inkling of the importance in the life of his wife of any decision he ultimately makes, and how right and fair it is to include her in those decisions, feels more constructive. But I reserve the right to write that letter when our future becomes a little clearer.

The sickness and anger I feel when I think about what has happened to us continues to debilitate me; to be so angry at the doctor is enough in itself to make me sick, but to be so deeply angry at a person (my husband) for whom I simultaneously feel equally deep sorrow and love is doing something really bad to me. I know I’ve got to come to grips with it, I’ve got to forgive my husband, the doctor and myself for my own good; I just don’t know how to do that at this point. How am I supposed to do that? At this point, my husband acts as though he doesn’t care about me at all. No affection, no nothing. I have to ask for a hug or a kiss. Sometimes he goes through an entire day without speaking to me. We sleep apart now. And I just go through the motions of the day and try not to think. I just stuff it down and down at every turn, with the only exception being these letters to you. Perhaps I do need to see a mental health professional of some type. I also realize ultimately there’s nothing to be done about it now. There’s nothing in the world that can be done. Maybe somehow we’ll get through this. Maybe we won’t, I don’t know.
Thank you for letting me talk about this. I really appreciate it. Thank you.

Rachael

Amy replied:

Dear Rachael:

But there really are things that you can do about this … starting today.

You need to begin at the beginning … and the beginning includes two things: (1) You need to tell your husband he is your best friend in the whole world, and you miss him, and it is hurting you. (2) You need to tell him that the depression about what has happened is killing you and you are going to get some professional help. Then you need to go get that professional help.

You need to take a first step out of the current cycle of regret and self blame and do something to change the dynamic.

Amy

My husband (we’ve been married 30 years) was diagnosed with possible prostate cancer (there was a ridge that was discovered on the prostate, and elevated levels of PSA — SO — the doctors (he got two opinions) recommended various treatments (radiation or surgery) and my husband chose a prostatectomy. I did some research and I begged, begged him to consider the robotic nerve sparing technique. But he liked the doctor he had been talking to, and this doctor was fairly close to our home, so my husband decided to put his trust in him. The day of the surgery came and after four harrowing hours of waiting, the surgeon came out and spoke to me, in front of a waiting room full of people, that all had gone well, and, he said this with a pleasant expression, and a smile on his face, he said “… and I did take the nerves on both sides. …”

I wasn’t able to process this statement at that point, having been 24 hours without sleep, and beside myself with anxiety, and feeling massively uncomfortable with the entire waiting room riveted on our every word. I only wanted to get to my husband, to be allowed back into the recovery room where he was … only later did it sink in. I accepted it of course, but when the prostate biopsy came back, the findings were that the cancer was very small and completely encapsulated within the prostate. The surgeon did not have to remove the nerves. He castrated my husband and destroyed any chance that we could recover our wonderful sex life, a sexual relationship that had been extraordinary for 30 years. And it had felt like some kind of a death to me, of course, not like what it would have been had my husband not survived the whole ordeal — but something has definitely been killed between us.

Now I am left with a terrible, deep-seated anger that I have to completely hide — that my husband would not even consider the robotic prostatectomy (as though I had no stake in the matter, that I shouldn’t interfere) which would have spared the nerves for certain and at least given us some hope of continuing what was a cornerstone of our marriage. … But now that’s over. And I have no idea what to do with this incredible anger I feel, also, so much toward the doctor, who was so sure of what he was doing and was so wrong — the hubris couched in that waiting room smile will stay with me the rest of my life — and toward my husband, who of course I am so worried about and feel so much sadness for (which I must hide of course as well) as I know this whole thing has devastated him, which he is hiding as well. We go on as if nothing has happened, but I am dying inside and I’m very afraid he is too. He has become petty and critical. I have begun to feel physically ill in a profound way, and I know there’s a connection to my horrible emotional state. I don’t sleep, can’t seem to digest food without pain now, I’m exhausted all the time and all of it is making me just sick. I weep as I write this.

Help me, Amy. Or anyone reading this. Anything.

Rachael

Amy replied as follows:

Dear Rachel:

So I have been thinking about this all day … and first and foremost let me very, VERY clear that your anger and your frustration and your tears are completely understandable. And now so is your husband’s sense of devastation. However, there are two very different things going on here that need to be dealt with as and when you feel able to do so.

The first is how do you and your husband are going to move forward. You need a way to be able to talk to each other about this. It is not about whether you made a right recommendation and he made the wrong decision. We will never know if that was true. But what we do know (assuming that what you are saying about the small, organ-confined cancer is true) is that that you husband seems to have had a self-absorbed jackass for a surgeon. You can’t both let that man’s actions rule the next 20 years of your lives. You just can’t! You need to be able to sit down with your husband and both “let go” of all these emotions that are boiling within you. Now you may need some help to do that, i.e., a psychotherapist or similar, or you may be able to do it on your own, but you absolutely do need to do it. Until you have done that, you are not going to be able to even think about addressing the whole sex-life issue … and there are things that can be done about that too.

You are both hurting too much to make any good rationale decisions about anything at the moment. You are both “missing your best friends” because you can’t talk to each other about what has happened … and you have to. Who else is going to understand better how you are feeling than your husband of 30 years? Who else better understands how he is feeling that you. He probably is feeling stupid and miserable and wants to cry as much as you do … but of course he can’t because you are both building separate walls around what has happened and is happening. You really need to stop building those walls and “let the light back in.”

The second is what you and your husband want to say to (or do about) that surgeon. There are a lot of things you can do and they range from writing him an absolutely stinking letter about your view of him as a physician on upwards. Obviously I have no idea about what he told your husband before his surgery (which is an important issue in all of this). However, again, assuming that what you are saying about the small, organ-confined cancer is true, his treatment of your husband would appear to have been unnecessary at best and unethical and incompetent at worst. It doesn’t have anything to do with whether your husband had open or robot-assisted surgery, however. Nerve sparing, when appropriate, can be practiced with great skill using either technique. The question is simply whether this surgeon knew what he was doing at all. I get the strong impression that he didn’t. Unfortunately he would not be the only surgeon practicing in America today who shouldn’t be let into an operating room … but that’s a whole different matter.

Amy

My father is 73 years old and was diagnosed with advanced prostate cancer (PSA = 125, with mets to the pelvis and spine) back in January 2009. Later, in September 2010, mets were also found in the dura mater.

At present he’s being treated with Taxotere. He has had five sessions (the last was 2 weeks ago) and his PSA is slowly decreasing (from 300 to 198 ng/ml). My main concern is quality of life. I don’t want him to suffer from pain. It breaks my heart to see him in pain. He takes Panadol and Endone for pain relief. It helps him but I’m afraid these will no longer work. He also suffers from pain in the jaw area, around his mouth. The radiologist said it could be Padget’s disease. Is there any treatment for this? Any advice on how he can gain some weight?

*****

Amy replied as follows:

Dear Jose:

Where do you live? Can you get “hospice at home” care for your father? There are other forms of pain medication that might be able to help that are stronger than paracetamol (Panadol) and oxycodone (Endone), but you and your Dad need to have a serious conversation with the oncologist about what you are all trying to do here.

If your father already has mets in his dura mater, it is my (very non-medical) understanding that there is no drug currently available that is going to do very much for very long to delay the progression of his cancer, and many of the drugs that are likely to get tried are more likely to affect your Dad’s quality of life than to extend it.

It seems to me that what is important here is for everyone to get focused 100% on managing the quality of whatever remaining life your father has, starting with thoroughly effective pain management. If that means something like morphine to palliate the pain, now is really not the time to be worrying that he might get addicted to a drug like this.

I am sorry I can’t offer anything more creative, but there comes a time when we all have to accept that modern medicine is not going to be able to offer life extension, at which point the important thing is to focus on quality.

Amy

Thank you for your advice. What you said is exactly in line with how I was thinking. I thought of the same scenario as to how he would feel if I told him I didn’t want him around while I was having breast cancer surgery! I even told him if he does drive himself to the hospital I will be driving there myself anyway because I fully intend to be in the waiting room while he is having his surgery and for post-op as well. He will stay in the hospital for several nights, so he knows he will not be under the effects of anesthesia, but yes, he also knows he will have a catheter and bag. Now that I know I am thinking on the right terms, we will talk. Thank you for the encouragement!

My husband is having a robot-assisted prostatectomy in one week, I know that he is struggling with this emotionally, as is expected. We have had many discussions about how this will affect him both physically and emotionally, and also the effects on our sex life.

Suddenly, 2 days ago, he has become very irritable (not surprisingly), but tonight he told me he wants to drive himself to the hospital for the surgery so that he can drive himself home. He doesn’t want me to be there before the surgery or when he is in recovery because he doesn’t know what his emotional state will be.

I know that I should only be thinking about what is good for him emotionally and not dwelling on my own feelings, but I am deeply hurt after 33 years of marriage to be pushed away like this. I feel like he is putting a wall up between us when I have told him I want to be there for him through all of this and this is a time when we should be closer than ever. He is a very masculine and strong man who has always seen himself as a strong protector and provider for his family, which he truly has been. Do you have any advice or guidance?

*****

Amy replied as follows:

Dear CK:

First and foremost, someone at his doctor’s office needs to tell him that he is not to even think about driving a car (or a truck either) within a few hours of having his surgery! He is going to be wearing a catheter and a urine bag. He will be disracted by how he feels after the surgery. He may feel extremely uncomfortable post-surgery. His reaction times will be slowed after his anesthesia … and the idea that he would drive himself home is not even close to smart! People aren’t allowed to drive home after they have something a simple as a colonoscopy!

Second, you need to tell him that if he wants to drive himself to the hospital withoout you, that’s just fine, but you will be driving yourself to the hospital too (or getting a friend to drive you there) because you have every intention of being right outside while he is having his operation and he’s just going to need to deal with it.

All of this is just one more example of his need to be “a big, strong guy” in the face of his considerable fear. You need to make it very clear to him that your being there during and after his surgery is not “up for discussion.” If you were having breast cancer surgery, he would expect to be driving you to the hospital, to be right there while it was happening, to be right there while you recovered, and to drive you home again afterwards. His emotional state before and after the procedure is not an issue. What is an issue is that in this particular case he is not writing the rules!

Of course you do need to tell him all this with a big grin on your face. Also, is there another example you can remember from 33 years of marriage when he pulled something like this and then had to “eat humble pie” afterwards when it didn’t work out? It might help to remind him (while wearing the same big smile)!

Amy

*****

Amy says:

Dear Dennis:

There are 1,001 opinions on how to optimize one’s life expectancy and the quality of one’s life after initial treatment for prostate cancer, but few of these opinions have been validated by the sort of research that gives really, really clear direction. A good, “heart healthy” (Mediterranean type) diet and regular exercise are among the most important things to focus on because they are good for your heart and for your prostate … and men are at much greater risk for cardiovascular problems that they are from their prostate problems.

One of the few real “experts” in this area is Dr. Mark Moyad at the University of Michigan. Here’s a link to a video you might want to have a look at. Dr. Moyad has also written a number of books about prostate cancer and lifestyle. One of his most popular is Promoting Wellness for Prostate Cancer Patients, which is now in its 3rd edition.

Hope that helps.

Amy replied as follows:

Dear Frank:

I don’t know any specific doctors in the Austin area who might be willing to write such prescriptions for you either. My suggestion would be that you contact leaders of local support groups of organizations such as Us TOO or Man to Man and ask whether any of their members can give you assistance.

Another possibility would be to contact advocates for this type of treatment such as Chuck Maack and see if they are able to offer you any ideas.

Hope this helps.

Amy

A client of mine recommended a book to read by Sheldon Marks, MD — Prostate & Cancer: A Family Guide to Diagnosis, Treatment & Survival. From what I could understand, the seeds used for brachytherapy would be radioactive for a period of time, but it did not say how long. It was recommended as you did, that the man who underwent the seed implant not hold young children on his lap for 2 months after the seed implant, or be next to them or to pregnant women for an extended period of time. The book states that the seeds come out in the urine or semen, so I assume that is why the recomendation for a condom for a few months after resuming sexual contact. What I would like to know is how long are the seeds radioactive? Are they radioactive up to a year? Or beyond?

Sincerely,

Terri

*****

Amy replied as follows:

Dear Terri:

The precise length of time that the radioactive seeds implanted in the prostate go on emitting radiation depends on exactly which radio-isotope is being used (iodine, cesium, others). It is, however, relatively short — of the order of 2 to 3 months. You and your [father? husband?] need to discuss that specifically with his brachytherapist or the brachytherapy nurse. You are correct that the fact that seeds can be dislodged from the prostate and expelled in the semen or urine is why a condiom is recommended for a period of time.

Having said that, the actual distance over which this type of radiocativity is effective is extremely short … more like millimeters than inches. The direction that patients should avoid very close contact with young children or pregnant women for extended periods of time is a precaution rather than an imperative. It’s more like telling one’s kids that jumping off walls 8 feet high onto concrete paving is likely to lead to the occasional broken leg. Most young children don’t actually risk jumping off walls 8 feet high onto concrete in the first place! As far as I am aware, there are no actual, reported cases of problems in any children or pregnant women as a consequence of being exposed to men carrying seeds after brachytherapy.

Would you interested in another web site on prostate cancer? It is at http://www.ProstateCareToday.com. We have put together some info on prostate cancer, especially for September, which is Prostate Cancer Awareness Month. Thank you for your time and hope you like it. And maybe share it with your readers if you think it is worthwhile.

Be well.

Andre

*****

Amy replied as follows:

Dear Andre:

Thank you for letting me know about your web site. I don’t make the decisions about which sites we link to from The “New” Prostate Cancer InfoLink, but I have passed the relevant information on to the people at Prostate Cancer International who do make these decisions.

With kind regards.

Amy

My husband is extremely fit and healthy. We are newly married and he had treatment brachytherapy and targeted radiation shortly after our marriage. Now he has totally lost interest in sex; I knew it was possible but I really don’t understand why there is no physical intimacy at all except brotherly pecks and hugs. I am devastated — not about the lack of intercourse but by the lack of any physical intimacy whatsoever; no lying together in bed; nothing. I am crying as I write this because I love him so much; he is hurt enough about this than to burden him with my feelings but I really am afraid that this is what our life will be. I can live without intercourse or even oral sex but no physical intimacy is scaring me because our relationship is so new. Am I being selfish; am I just awful for even feeling this way?

*****

Amy replied as follows:

Dear “Atticus”:

While your husband may have been profoundly affected physically and psychologically by the effects of his brachytherapy, you both made a commitment to each other that came with your marriage vows … “To have and to hold, for richer, for poorer, in sickness and in health …”

Getting beyond where he and you are today is going to take some hard work, and that hard work is going to have to begin with some real honesty. He needs to talk to you — and perhaps to a health care professional too — about the emotional and psychological distress that has resulted from his treatment. He undoubtedly feels emasculated in any number of ways, and men commonly have no idea at all how to cope with those feelings. You need to be able to talk to him about the emotional and psychological distress that his disinterest in intimacy is causing you. You are absolutely not being “selfish” or “awful” for feeling the way you do. This is about both of you.

Did your husband have (or is he still having) hormone therapy in association with his radiation? What you describe sounds very much as though he might have done.

The situation is undoubtedly not being helped by the fact that both of your short-term, personal sets of expectations — “bedroom-wise,” so to speak — have been turned completely upside down. And something needs to happen about that too. You both need to start all over again with what you want intimacy to mean for you, and then decide what you are willing to do to accomplish that. This most certainly may place a requirement on you to take on a more demanding and commanding role in that part of your relationship. It is even possible that your husband would welcome that, because one of the things that goes on in these situations is that the male’s sense that he is some sort of “failure” colors everything about his view of intimacy.

Here’s one thing that you can most certainly do. Buy yourself a copy of Dr. John Mulhall’s Saving Your Sex Life: A Guide for Men with Prostate Cancer. You can get it from Amazon. As a couple, you may or may not be interested in trying all of the things that are referred to in that book. It is often blunt and straightforward. However, it will give you a sense of what is possible, and above all it will give you a starting point to discuss the problem. Once you have read it yourself, you can wrap it nicely and give it to your husband and tell him that you and he are forming a study group, ‘cos it’s time to talk about your sex life for the next 20 years. Then (perhaps) you can take him into the bedroom (with the book) and make it clear to him that this study group will work better when both students are naked. He very definitely needs his ego boosted. You may also need to tell him in words of one syllable (so to speak) what you need. This is not something a lot of women are well trained in. Many of us spent our sexually formative years being trained in how to say “No” as opposed to how to say, “Yes, just like that, and now please.”

Finally, you need to know that as a couple you are two steps ahead of where a lot of couples find themselves. At least your husband does understand that he needs to give you hugs and brotherly pecks. It’s a start, but for some couples the male is so traumatized by his loss of libido and sexual function that he doesn’t even recognize that need!

Time for you both to stop feeling sorry for yourselves individually and take charge of the situation!

:O)

Amy

—–

Amy responded as follows:

Dear Tony:

Probably I am just being my usual relatively naive self … but … I have absolutely no idea what you are talking about! Perhaps you need to be more specific.

Amy

I have been diagnosed with prostate cancer. I am 42, love my wife deeply, and have three young children (7.5 years, 6 years, and 18 months). We live on the West Coast (LA) but I work in the DC area, which means I’m on a flight every Monday morning and back to LA every Friday evening.

Are there any circumstances under which I shouldn’t or wouldn’t tell my wife and eventually my kids about my diagnosis.

I was considering not telling her and just dealing with it by myself. I feel that this would be the best scenario for her and the kids and would allow me to focus on treatment and hopefully recovery.

Am I thinking straight?

thanks,

dc

*****

Amy’s reply follows:

Dear DC:

I understand that you think that by not saying anything to your wife you believe you may be saving her from worry and other potential consequences … but I would gently suggest that if the situation was reversed, and she had been diagnosed with (say) cervical cancer, you would be mortified to find out that she hadn’t told you in order not to worry you.

First, a very great deal about your prognosis and treatment depends on the extact nature of your diagnosis (the clinical stage, the Gleason score, your PSA level, and the amount of cancer in your prostate). Second, how you get treated (which may depend on the details of your diagnosis) is potentially going to have some significant consequences that just aren’t “hideable.”

At this stage there is certainly no need for your children to know about this, but your wife — at least in my view — very definitely does. You are going to need her help and support. And she has every right to know what is going on.

You are relatively young. If you have early stage, relatively low-risk disease, you have a good chance of curative therapy and a good subsequent recovery, but this is not something you can successfully hide for very long, and if you love your wife deeply and she loves you the same way, why would you want to? … “For better for worse, for richer for poorer, in sickness and in health” … Remember?

Oh … and one other thing … Sooner or later you will need to tell your male kids about this because they are at potential future risk through family history. You may not need to do this until they are in their later teens, but you and your wife may want to think about making sure that the kids are brought up on a very “heart healthy” diet in order to minimize the small risk that dietary factors (e.g., too much fat in the diet) can be a possible cause of prostate cancer.

Amy