Jerry, you have my heartfelt sympathy. This inability to settle on a Gleason score with the prostate in hand is unsettling. Maybe they just mis-labeled your slides.
If you do the homework, and you did, you should be able to expect a good outcome, consistent with your situation going into the surgery. At least you're dry! I hope you are getting upset for no good reason.
I've read studies where a small amount of benign prostate tissue will be left behind and produce a small and fluctuating psa. Of course, the number never goes anywhere significant if it is benign. I've had the same issue with conflicting PSA numbers, my GP uses a lab that reports .01, my urologist's lab reports .1 So far my insurance has not complained about getting psa tests from both the GP and urologist.
>>> I agree with Zufus, I'd have my eye doctor request a psa if I though he would do it. There is no such thing as too much information.
Both doctors claim that their number is "undetectable", with the GP agreeing to short term testosterone replacement therapy two months after the surgery. The urologist is probably still not speaking to him.
I have a few questions to pose to the group (and I'm going to pose them to my urologist/surgeon at our July meeting):
If you have a robotic RP, like Jerry, shouldn't your surgeon be able to carefully inspect surrounding tissue, take a snippet of lymph tissue or any other suspicious tissue for immediate pathology review? With the camera illumination and magnification available with the Da Vinci, shouldn't he see suspicious tissue? This is touted as one of the big pluses of going Da Vince rather than open, the ability to see under, around, big and bright, and in 3D.
We may be getting into a new area of concern, where time on the Da Vinci is so tightly scheduled that the surgeons are rushing the surgery.
If there is any question re: malignant vs benign tissue, can't the hospital do immediate pathology work even prior to removing the prostate? They do this with other surgeries. Biopsies and the resulting Gleason are notoriously iffy, the surgeon must have some indicators when he gets in there as to extent of the cancer. Going in, my surgeon said he didn't think that there would be any problem keeping the nerves, based on my numbers, but he couldn't promise until he was actually there. That indicates to me that there is some visual indication of the extent of the cancer.
Another question, unrelated to this post, but still relevant to our group, and something I've been wanting to ask: Is there really any purpose to doing a DRE anymore to Dx PCa? I understand that it is an insurance reimbursible procedure, but does it really identify any Pca that the psa test would not catch much earlier? I guess my real question is, if your psa is below the threshhold for concern (and prostate size, condition, presence of BPH can create a pretty big psa number by themselves), is there a possibility of a "silent tumor" that does not generate a significant psa number and needs to be found by some other means? Can a tumor be manually detectable without creating a psa number that would indicate a biopsy?
Finally, a comment: Jerry might not have had the renowned surgeon he so carefully sought out actually do the surgery! His assocates have to learn somewhere, somehow, sometime. His surgeon was undoubtedly there, but it may have been another's hands at the Da Vinci console.
Where is the post about the doctor who took part of the prostate out?? I'd like to read it.