Did your uro offer you other treatments besides surgery?  If so did
your uro lead you to believe surgery was your best option?

tired at night and stress incontinence and slowly >unevenly improving
ED after 1 1/2 years, plus GIRD from lying >down and arthritis from
muscle loss-now better.Hassle but

You don't know what you are talking about.   You constantly tend to see
things in stark black/white categories and you seem unable to make
distinctions.  Walsh is a surgeon and probably reflects a surgeons bias,
but he is not blind, virtually or otherwise, to alternatives.

In Guide to Surviving Prostate Cancer, he is quite positive about
radiation as a primary treatment for prostate cancer.   In the 80s,
radiation was not very successful at treating early prostate cancer, and
most urologists reflected that in their recommendations even into the
early 90s.  The problem was that they couldn't supply an adequate dose
to kill the cancer without significant damage to surrounding tissues.
But, as Walsh makes clear in his book, modern methods of radiation can
focus the radiation on the prostate and avoid damage to surrounding
tissues.  As a result, much higher radiation doses are applied to the
tumor, and the therapy is much more effective.   In his book, the only
doubt he raises about external radiation is that long term results are
not yet in.  He makes the point that we just don't know how external
radiation compares to surgery for over 10 years, and that is correct.
But his book is now four years old, and more data is in.   I wouldn't be
surprised if he was even more positive about radiation in his next book.

It is true that he is negative about the advantages of brachytherapy
over external radiation.  I tend to agree with him about that.   I don't
see a whole lot of point in brachytherapy.  If I had chosen radiation, I
would have chosen external radiation.  Brachytherapy certainly has its
advocates, and Walsh may be proved wrong about this.

Walsh is also quite negative about using hormone suppressing therapy as
a primary treatment for early prostate cancer.   From what I've read,  I
think he is absolutely correct about this.  In this, I believe he
reflects wide spread opinion among experts in the treatment of prostate
cancer.   There is a very small group of oncologists who think hormone
therapy is appropriate in such cases,  mostly when there is a strong
possibility that the cancer has already spread.   They may of course be
proven correct, but right now I don't see any evidence that they are.
Of course,  all experts agree that hormone therapy is appropriate for
metastatic prostate cancer.   Here Walsh thinks that such therapy can be
delayed until overt symptoms occur, and he quotes some research
supporting that in his book.  But there is some current evidence that
earlier use may extend life in some cases of metastatic prostate cancer.
  I think the situation is unclear on that subject, and we shall just
have to wait to see what research in the subject reveals.

Walsh is also pretty negative about using surgery or any aggressive
treatment to try to cure prostate cancer in older men.   He readily
admits that such cancers are not likely to cause a problem during the
lifetime of the patient and they are better off being treated with
watchful waiting followed by hormone therapy if necessary.  He even
questions whether such men should be given routine PSA tests.

I think you are out of date about Harvard.  They are now doing lots of
radical prostatectomies at Harvard related hospitals in Boston.  Several
 men who post at alt.support.cancer.prostate have had prostatectomies
there.   Here is a quote from Harvard's Dana-Farber Cancer Center's website.

"Patients in good health who are younger than 70 years old are usually
offered  surgery as treatment for prostate cancer."

This is pretty consistent with general practice and certainly with what
Walsh does.  But some other urologists will suggest surgery in some men
over 70.  It is really not age that is relevant, but life expectancy.
Surgery is usually considered a reasonable choice for men with moderate
cancers (Gleason 5-7 and PSA under 10) and a life expectancy of at least
10 years.   It is also sometimes suggested for younger men (under 60)
with Gleason 8 and/or higher PSAs, although it is not clear it will be
helpful in such cases.  The argument is that it is the best chance the
patient has for a cure, albeit uncertain.

In any event, there is no evidence that any other method of treating
early prostate cancer is more effective than surgery at curing the
disease.   Don't you wonder why no one has suggested a double blind
randomized study comparing external radiation or hormone therapy to
dummy procedures?  It is because they recognize that there is no point
in it.

I had given you credit for being consistent about this in believing that
 there is no proof that any method of treating prostate cancer is
superior to watchful waiting (followed by hormone therapy if the cancer
metastasizes).  If you are one of those who just rail against surgery,
I am disappointed in you.

All current methods of treating early prostate cancer aim to effectively
destroy the prostate along with any cancer contained therein.  Surgery
removes it entirely, radiation zaps it, etc.  They have very similar
side effects because they all basically do the same thing.  Any man who
wants to have his prostate cancer treated should thoroughly explore the
advantages and disadvantages of each available method and choose
accordingly.  Often the skill and experience of the doctors he has
available may be more important than the treatment method.   He should
not be scared off by words or irrational fears about being "cut".

What other options would he consider?  And why would he always exclude
surgery?

I am not sure what you mean by DNA ploidy.  There is some very recent
work on trying to judge the aggressiveness of a prostate cancer using
modern DNA technique.  Hennenfent is not involved in this research, and
I have not seen any indication that it is now being used in clinical
settings.  It is recognized by everyone that when such technologies
become available, they will help enormously by reducing the number of
cases which need to be treated aggressively.

The rate of growth of PSA is a criterion used by all people who treat
prostate cancer.   It is used first of all in order to determine if a
biopsy is necessary.  There is also some current research (by Catalona
and others) which suggests that if PSA grows faster than 2.0 ng/ml in
the year preceding diagnosis of prostate cancer, then the cancer is more
likely to spread.   It would be important, I think, to treat such a
cancer immediately rather than following it further.   PSA rate of
growth is also used o monitor the treatment of advanced metastatic
prostate cancer, but that is just to determine if the treatment (by
hormone suppressing drugs) is still working.   When that treatment
fails, as it almost always does, unless the patient dies first of
something else,  there is not much left to do except try various
experimental approaches.

The Gleason score has been used for years to estimate the aggressiveness
of prostate cancer.

Unfortunately, none of this information, or even all of it together, can
at present, with high reliability in many patients, allow the doctor to
determine when more aggressive action is needed.   If an early cancer is
not treated aggressively,  it may metastasize at any point, and then it
can't be cured.   Whether metastasis will happen ever and when it will
happen if it does are impossible to determine given current knowledge.

For older men, it is often worth taking a chance that the cancer will
never develop into a problem during the patient's lifetime.   For some
men in their late 60s with a Gleason 6 tumor and other indications that
the cancer is small and non-aggressive, it seems worth following the
patient to see what happens.  But for most men under 70 and some over 70
in good health, it seems prudent on the basis of current knoweldge to
try to eliminate the tumor by aggressive therapy,  either surgery or
radiation.   Such therapy is extremely effective at doing this in a very
large number of cases.   For example, a man with a Gleason 6 tumor and
PSA less than 10,  thhe chances of the cancer showing signs of recurring
through a PSA rise within 10 years of such treatment is over 90 percent.
 So there is no question that many men who receive such treatment do
well.  The open question is how many would do just as well if they were
not treated at all.   Most urologists and radiation oncologists think,
on the basis of the evidence so far,  that treatment improves the odds
signficantly.  Some skeptics dispute that, and perhaps Hennenfelt is one
of them.  But it is important to remember that at present, no one really
knows for sure.