Prostate cancer is a pressing health concern in the United States and one surrounded by continual controversy. Currently there is no consensus regarding the efficacy of routine screening, nor has one treatment modality been demonstrated as superior. Patients and spouses are asked to choose from several options: radical prostatectomy, radiation therapy, or the "watch and wait" approach. A grounded theory design was used to examine the actual treatment decision-making process as it occurred over time among 18 newly diagnosed prostate cancer patients and their wives in western North Carolina. Couples were interviewed conjointly and individually to explore their perceptions of the decision process. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis techniques. Couples negotiated decisions through their common and unique personal and family histories, biases, and individual coping styles. They narrowed the options based on these factors. Most couples received their counseling regarding treatment options exclusively from the surgeon who narrowed the options based on age and physiologic status. Most couples chose surgery believing it to be the only treatment promising cure. Distinct misconceptions about radiation therapy were noted. Concern about potential side effects did not deter men from selecting surgery, although men and their wives differed in their willingness to accept treatment "at any cost." Information regarding potential for cure and risk of recurrence were highly important factors in the decision process. The decision was incomparable with any other life decisions the couples had faced.