A 72-Year-Old Man With Localized Prostate Cancer

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Abstract
Dr Daley:Mr S, a 72-year-old retired architect, was found to have carcinoma of the prostate in early 1994. Married and the father of two grown children, he is writing a book on American naval history. He is insured by Medicare and carries supplemental insurance. For editorial comment see p 76. His medical history is remarkable for angina pectoris followed by coronary artery bypass graft surgery in 1981, peptic ulcer diagnosed in 1981, heavy smoking 30 years ago, and hypercholesterolemia treated with nicotinic acid. A thallium exercise scan performed in 1993 for recurrent angina revealed a reversible perfusion defect in the posterolateral wall, although since beginning treatment with diltiazem he feels well and is not limited by pain. In 1992, Mr S went to Dr K, his primary care physician of 8 years, for a routine checkup. Dr K performed a rectal examination and noted a new slight induration of