Yes, Gleason 6 is moderate, or not very aggressive.

Men over 70 are not normally offered surgery.

Did the doctor mention the somewhat controversial concept of watchful
waiting, or just keeping an eye on developments?  That would be a
logical choice for a man over 70 whose life expectancy is less than 10
years or so because of some health condition other than PCa.

I'm not recommending watchful waiting, just mentioning it.

jimhoney
not a doctor

Probably T1c.

Yes.  It is.

You can get most of the answers to your questions by reading any one of
a number of good books on prostate cancer.  Many people recommend
Patrick Wlash's "Guide to Surviving Prostate Cancer".  A recent book, by
Glen J Bubley, "What Your Doctor May Not Tell You about Prostate Cancer"
may also be helpful.  It is written by an oncologist who has no vested
interest in treatments for early prostate cancer such as radiation or
surgery.

It is thought that both methods produce very similar results for up to
10 years.   Before the 90s, radiation had a bad reputation.  The problem
was they couldn't apply sufficient radiation without significant damage
to surrounding tissues with the techniques then available.  But since
then, several improved methods for focusing the radiation where it is
needed have allowed much higher radiation doses, so the method is much
more effective.  Radiation may also be just as effective as surgery in
the longer term, but the data is not in yet.

If the possibility of impotence is important to your father, radiation
could be a better choice.  Skilled surgeons have a good success rate at
avoiding impotence for younger men,  but for men over 70, it drops to
under 30 percent.   Impotence rates for men that age after radiation may
be more like 50 percent.  In either case, there are a variety of
treatments for impotence, so it is not necessary to give up on sex.  But
the effectiveness of drugs like Viagra may be higher for older men whose
cancer was treated by radiation.

Another reason possibly to favor radiation is that surgery tends to be
rougher on older men.  Also, since they are not likely to live as long,
the possibility that the cancer may recur may not be as important.

For a man your father's age with his diagnosis, it is possible under
some very restricted circumstances that it might make sense not to treat
the cancer immediately but to monitor it.   Prostate cancers are very
slow growing, and in most cases will never bother an older man during
his life time.  But this can be tricky because the cancer might
metastasize while it is being monitored, and then it can't be cured.
Walsh. in his book, describes circumstances in which this might be a
reasonable course of action.

I can't add much to Leonard's excellent reply, but I'll
join him in saying that watchful waiting is potentially
risky.  Your father's doctor's optimism is probably
very justified now.  But if the cancer develops further,
the cure rates from treatment will go down.

Also, both of the available curative treatments, surgery
and radiation, do some violence to the body.  They may
be easier to handle and recover from at age 71 than
at later ages.

The choice between radiation and surgery is much
debated on this newgroup, with some partisans on
each side.  It is my impression that both treatments
work well when properly done.  But it is possible to
do either one badly and either fail to destroy the
cancer or exerience more damaging side effects.
Therefore, when evaluating the treatment
options, your Dad also needs to evaluate the doctors.

If possible, you want a doctor that specializes in
treating prostate cancer and does many treatments
each year, as opposed to, for example, a surgeon who
primarily does other operations but also does a
prostatectomy once a month or so, or a radiation
oncologist who mainly works on breast cancer but
works on a prostate once a month or so.

If your father has more confidence in one doctor than
another, that might be a factor in his choice of
treatment.  If he doesn't have full confidence in
either one, then by all means, try to find someone
else.

I'll go out on a limb and say that the treatment with
the least side effects may be brachytherapy, i.e.,
implanting permanent radioactive seeds.  The procedure
is done in a hospital, usually with an overnight
stay.  The patient will be up and walking the same
day and probably go home the next day.  There will
likely still be side effects but, for many men, they
are very mild.

Brachytherapy by itself is less effective for more
advanced cancers than your father's.  For more
advanced cases it may still be used, but is often
combined with hormone therapy and external beam
radiation.  However the cure rates for cancers that
are caught early are very good.

Don't take my speculations too seriously.  I'm not
a doctor.  But brachytherapy is something your Dad
might want to ask his real doctors about to see if they
think it is a good option for him, and if it is likely to
involve less treatment and less side effects than other
modalities.

   Alan

Thank you very much Alan, Leonard and Jim for your informative replies.

Although my father is 71, he is in excellent physical and cardiovascular
health. As a result, his urologist (who no longer does surgery and who
happens to be a prostate cancer survivor himself) as well as the surgeon
he spoke with believe he would be a very good candidate for surgery.

While intially my father was considering radiation, I think he is now
leaning toward the surgery.  He read Dr. Walsh's book as well as a few
others and researched on-line as well.  Because he's had an enlarged
prostate for so many years, he'd kind of like them to just take the thing
out.  Also, should there be a recurrence, I think he feels he would have a
more viable plan b than if he did radiation (seeds or otherwise) now.

He has an appointment with Dr. Tewari at Cornell Medical Center next week.
He is one of the top guys in the robotic surgery field and apparently has
done hundreds of these things.  He also has a wonderful manner and even
called my father at home and had a lengthy discussion with him.  I think
he will be in very good hands should he choose to go this route.  

I'll apprise you of his final decision.  Thanks again for all your
advice.
Jennifer