DEAR DR. DONOHUE: My brother was diagnosed with prostate cancer a few months ago. His doctor told him he was too old to be operated on. Why? He is to get some sort of shots. I would like your opinion. He is 80 and has diabetes. – M.H.

ANSWER: Many factors have to be considered before choosing the best prostate-cancer treatment for an individual. General health and the ability to withstand major surgery are prime considerations, considerations much more germane than age. Your brother’s health might have been the reason he wasn’t treated surgically.

The “stage” of the prostate cancer is another important issue. Stage indicates how deeply the cancer has penetrated the gland and if it has spread. If the cancer has attacked distant sites, then surgery isn’t the usual treatment option. Such cancer is still treatable, however.

Your brother’s treatment is called androgen ablation – cutting off the production of the male hormone testosterone. Testosterone fosters the growth and spread of prostate cancer. Eliminating it prolongs life and slows cancer progression. That’s the treatment your brother’s shots are going to achieve.

You can trust your brother’s doctors with having considered what would be his best treatment in light of the many aspects that affect his life and his cancer.

The prostate booklet goes into the details of prostate cancer, prostate enlargement and erectile dysfunction. Readers can order a copy by writing: Dr. Donohue – No. 1001, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am a 50-year-old man who was diagnosed with prostate cancer at 49. My cancer was discovered early. The urologist said I had to have the entire gland removed. My age made me a prime candidate for laparoscopic radical prostatectomy. My chances of retaining the ability to have an erection were 85 percent to 95 percent. Well, that was a year ago, and I still cannot have an erection. I have the desire, but that’s as far as things go. It is hard for me to get close to my wife because I don’t want to start what I can’t complete. I have tried Viagra, Levitra, alprostadil, combinations of those medicines and the pump, but none has worked. My wife is dealing with this a lot better than I am. If you have any advice you can give me, please do so. – L.W.

ANSWER: A radical prostatectomy entails removing the entire gland – a major feat – and adjacent lymph nodes. Nerves that control erection run very close to the sides of the gland, and avoiding any injury to those nerves is difficult but possible. It can take two years after surgery before those nerves recover. You might be one of those who must wait the entire 24 months.

If, after two years, erectile dysfunction persists, then try the medicine route again. Should it be unsuccessful, discuss with your urologist the many implantable devices that can make sexual relations possible.

DEAR DR. DONOHUE: My husband feels like food gets stuck in his throat, and he feels the sensation behind his breastbone. He has had scope examinations in the past, the most recent one five years ago. The doctor stretched the opening at the bottom of the esophagus, but my husband did not get any relief for his swallowing. He also has bad-smelling breath, like nothing I have ever smelled before. Any thoughts on this situation? – V.L.

ANSWER: Your husband should check back with his doctor and inquire about Zenker’s diverticulum. It’s a pouch that forms in the back of the throat, much like a hernia sac. People with the diverticulum have a hard time swallowing, particularly solid foods. Foods get stuck in the pouch. Food that stays there for a long time undergoes partial digestion, and that gives rise to foul breath. Pain on swallowing can be experienced in the throat or lower down, at the top of the breastbone.

The diagnosis is made easily by having the person swallow some barium and taking an X-ray picture. The barium enters the diverticulum and outlines it. Surgical correction is possible.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com