(FORTUNE Magazine) – Breast cancer is expected to kill 44,300 U.S. women this year. Prostate cancer will kill almost as many men, 41,400. Yet there's a striking difference in how the genders deal with their sexually threatening scourges. Ask a woman about breast cancer, and she's likely to roar that the government had better fund more mammograms pronto, or a certain Congressman is going to get fried. Ask a typical male about prostate cancer, and he'll reply, "How 'bout them Cowboys?"

Thanks to this grittiness gap, the effort to mobilize for a war on prostate cancer lags behind the one on breast cancer by about a decade. This year the U.S. National Cancer Institute will spend more than five times as much on breast cancer studies as it will on prostate cancer ones. The gap is even greater at the Defense Department, the government's No. 2 funder of cancer research: over the past five years it has earmarked $485 million for breast cancer, compared with less than $20 million for prostate cancer.

Research administrators squirm when pressed about the funding gap. Mostly male scientists, they hate to admit that female activists are calling their square dance. After all, they supposedly set priorities in a disinterested, scientific way. Here's how Edward Sondik, Ph.D., the NCI's science policy director, tries to explain it: "We've learned an enormous amount about breast cancer and have a lot of clues [that warrant follow-up studies]. In prostate cancer we're just not as far along."

This logic is hard to reconcile with the soaring budget for AIDS research. Federal officials, pushed by gay groups, aimed big bucks at the newly discovered disease when there were few clues about it. Last year the National Institutes of Health spent a whopping $1.3 billion on AIDS, which kills about the same number as prostate cancer does. Hundreds of top scientists have rushed to the AIDS Klondike, generating a bonanza of findings that now are beginning to pay off with palliative drugs.

Taking a cue from AIDS activists, women in 1991 began a concerted push for more breast cancer research. Says Cynthia Pearson, program director for the National Women's Health Network, an advocacy group: "The federal response had been, 'We can't put a huge increase into one area because there wouldn't be enough good science.' " But a coalition of women's groups convened a panel of experts, who concluded that potential studies on the disease were crying out for research funds, to the tune of $300 million. Meanwhile, "because of the 1992 elections and Anita Hill, suddenly many men felt like they needed to do something for women," Pearson says. Finger in the wind, Congress voted to boost DOD breast cancer funding by about $200 million just before the election.

Big payoffs from breast cancer research are still to come. But there's no doubt the money is talking. Here's a recent box score from Medline, the government's computerized database of medical research: Breast cancer: 34,216 studies. Prostate cancer: 5,224. AIDS: 85,536.

Such numbers are a strong motive for men who have battled prostate cancer to come out of the closet. General H. Norman Schwarzkopf, Senator Bob Dole, and Michael Milken, among others, have raised the disease's profile by publicly discussing their cases. Milken has gone further--a charity he set up, CaP CURE, has awarded $23 million for prostate cancer studies over the past three years, making it the nation's second-largest funder of such research.

But what's really advancing the wimpy gender's cause is help from the stronger one. When men with the disease met at a Chicago hospital a few years ago to form a support group, they turned to Sharon Green, executive director of Y-Me, a breast cancer group. Following her recipe, they cooked up Us Too, which now has about 400 chapters worldwide. This spring, Julie Freestone, a Richmond, California, firebrand who has a relative with prostate cancer, initiated an activist group via the Internet to spur Congress to fund more studies on the disease. Says she: "I was monitoring a prostate support group on the Net and realized no one was doing anything" about research funding. "Men are loath to discuss a disease that goes to the heart of their sexuality."

The "I" words are especially fearsome: Treatments often cause impotence and incontinence. Says William Fair, a urologist at New York City's Memorial Sloan-Kettering Cancer Center: "When I ask a man 'how's sex?' after treatment, he'll often say fine, and I'll look over at his wife and she's shaking her head no." Since testosterone fuels the disease, desperate cases are sometimes treated by castration. Even diagnosis, which typically involves a doctor rectally palpating that dangerous walnut down there, speedily rivets most any old boy on the Cowboys. Let's face it, guys: Prostate cancer catches us with our pants down.

But most any old boy is likely to be caught that way. A study of autopsies of men who have died from various causes show 40% of men in their 50s have prostate tumors, 50% in their 60s, and so on. These cellular explosions usually occur in slow motion compared with tumor growth in other organs--it is often said that many more men die with prostate cancer than of it. But a recent examination of 90,000 death certificates by Drs. Robert A. Stephenson and Charles R. Smart at the University of Utah takes the shine off that old saw: They found that a surprisingly high proportion of men diagnosed with the disease die of it--for instance, about 40% diagnosed in their 60s and 30% in their 80s.

The Utah study hasn't yet been peer-reviewed, and its results may be slightly off--death certificates are sometimes wrong. Still, it should help topple a potent, if seldom voiced, argument: that competing causes of death usually kill before prostate cancer does, so research dollars are better spent elsewhere. It also weakens the case for "watchful waiting" after diagnosis, as opposed to surgery or radiation--although a reasonable case can still be made for waiting, as Tom Alexander shows in the previous story.

Even before the Utah study, the stiff-upper-lip approach to prostate cancer was looking shaky. It is based mainly on older studies, in which subjects often were diagnosed late in the course of the disease with relatively crude methods--many prostate tumors can't be felt via digital rectal exams until cancer has metastasized. In such cases, treatments rarely extend life much. Thus many of the studies made treatment seem futile. But with the 1986 advent of the PSA test, based on a telltale substance in the blood, doctors are detecting the cancer much earlier, often when it is still curably localized in the prostate. Now data are emerging that suggest screening for and treating the disease make sense. Besides, dying of prostate cancer is a sorry ending--often a long agony compared with death by more mercifully swift diseases.

The PSA test is causing a political, as well as a medical, sea change. Early detection has made the number of cases explode--currently, estimates of prostate cancer's incidence make it the most frequently diagnosed kind. That has suddenly created public urgency and a walloping constituency. Many younger men diagnosed these days tend to be more assertive than their fathers when dealing with doctors. They should be, for early detection gives them a better chance, especially if they act up and demand the best. Wired to the Internet, some are more conversant than their physicians with recent findings. And many are concluding that the medical establishment is behind in its homework.

For prostate cancer, the establishment is urologists--they generally oversee treatment. But urologists are surgeons; trained to cut, they do. Some 95% of urologists said they recommend excising the prostate in patients under 70 with tumors localized in the gland, according to a survey published last year in the Journal of Urology. Another 1995 survey, conducted by Louis Harris & Associates for Us Too, suggests that like sheep stampeded into a pen for shearing, men usually head for the knife soon after a prostate cancer diagnosis: About six in ten said they'd had a radical prostatectomy, or RP--almost exactly the proportion that seemingly have localized, hence excisable, tumors at diagnosis.

Urologists refer to RP as the gold standard of treatment. They cite reams of data showing that if cancer cells haven't escaped the prostate, removing it cures the disease. True, they concede, RP is a big, tricky operation, typically followed by up to a week in the hospital, more than a month of recovery, and lingering side effects. The Harris survey indicates at least 75% of men "experience impotence" afterward. But gold, after all, isn't cheap.

To some experts, however, RP is beginning to look like fool's gold. A relatively new alternative, computer-guided implantation of radioactive seeds in the prostate to kill tumor cells, appears to work at least as well as RP does to stop early-stage prostate cancer (see "Taking On Prostate Cancer" by Andy Grove). This "brachytherapy," combined with "external beam radiation," appears superior to RP for more advanced cases. Seed implants are cheaper and, in experienced hands, tend to have less severe side effects than RP--patients typically go home a few hours after seeding. The Harris survey found that only about 6% of patients have had brachytherapy--exactly the percentage of surveyed physicians who recommend it for localized tumors.

Urologists are understandably reluctant to see the $15,000 or so RPs they do replaced by cheaper, outpatient seed implants overseen by radiation specialists. Self-interest probably isn't the main reason they prefer RP, though. Urologists want to do the best thing for patients, and their reading of the literature suggests that's usually RP for localized cancer. But many of them simply aren't familiar with emerging brachytherapy data. Moreover, urologists traditionally think and speak of RP as "cutting tumors out and getting rid of them." But that overrates the surgery's cure rate. The PSA test, a kind of early-warning radar for recurrence of cancer, has shown that it reappears much more frequently after RP than doctors once thought--apparently, many cases that appear localized in the prostate aren't.

Last year the American Urological Association issued the closest thing to a bible on early-stage prostate cancer. The report is inconclusive--its authors cite a lack of comparable data from various studies. Still, they go on to compare results from the best studies in a summary table. It indicates that five years after treatment, cancer is less likely to recur in patients who had RP than in ones opting for brachytherapy. But the brachytherapy data are based on an outdated technique, and the panel states that five-year follow-up data aren't yet available to assess a new, improved method. It acknowledges, however, that there's "no evidence that the results from [the new way] are inferior."

Yet four months before this pointedly faint praise was accepted for publication, exciting follow-up data on the new brachytherapy method was accepted for publication by the same urology association that convened the bible-writing panel. These data show that in patients followed for one to seven years after seed implants, the apparent cure rate is at least as good as that following RP in similar patients with early-stage tumors. These promising data didn't appear until two months after the bible was accepted for publication last July. John Blasko, a radiation oncologist and co-author of the seed study at Seattle's Northwest Hospital, sees nothing Machiavellian here: "There's a real logjam getting information out" about the new method. Indeed, a spate of data about it awaits publication, including more follow-ups that show the promise of seed implants is holding.

Pioneered a decade ago in the U.S. by Blasko and urologist Haakon Ragde, a native of Norway, the new method greatly improves on the older one, which was introduced in 1972 and mostly abandoned after disappointing results. The novel technique couples high-tech imaging and computer software to place seeds with far more tumor-killing precision than previously possible. It's not a panacea, nor is it side-effect free--frequent urination commonly occurs for months afterward, and brachytherapy can damage the rectum and urinary tracts. It's tricky--you don't want to be a budding brachytherapist's first patient--and even brachytherapy enthusiasts fret that if it becomes a fad, novice doctors will jump in and cause a backlash from sloppy implants. Still, "many patients are going to insist on it," says Kent Wallner, a radiation oncologist at Sloan-Kettering.

Ironically, some HMOs and other insurers refuse to pay for it, while rubber-stamping more costly RPs. Says Rick Ward, a Deer Lodge, Montana, resident who wrestled with the Veterans Administration for eight months before it approved his seed implant: "It's bizarre. I had to fight like hell to go the cheap route." Soon after his seed implants this spring, Ward formed an Internet group to push for a medical paradigm shift. "In ten years, RP will be seen as a barbarism," he declares.

Inklings of a shift are appearing, most tellingly in the form of urologists favoring implants for themselves. Edward Ackerman, a 61-year-old urologist in Orlando, had a seed implant himself last year after helping perform the procedure on hundreds of patients. Says he: "I felt there was just as good a chance it would be curative as an RP. Two days after the procedure, I was playing golf."

Reporter Associate Bethany McLean