(snip)

The Gleason score bears little relationship to PSA. It is what it is
entirely based upon a pathologist's microscopic examination of prostate
specimens and *nothing else*.

The Gleason and PSA are not visible physical manifestations, seen during
surgery.

'Fraid not.

I'm not qualified to judge, but I do believe that John has not followed
my July 15 advice to refer to the comprehensive and objective website of
the Prostate Cancer Research Institute at:
http://prostate-cancer.org/index.html

There, he will find authoritative information that should put to rest
his nightmarish fears. There are enough real matters to worry about
without imagining more.

And in the name of Heaven, don't select tx based upon patients' stories
to be found online. What someone else, including me, has experienced may
not apply to anyone else in the Universe.

Regards,

Steve J

"What are the facts? Again and again and again -- what are the facts?
Shun wishful thinking, ignore divine revelation, forget 'what the stars
foretell,' avoid opinion, care not what the neighbors think, never mind
the unguessable 'verdict of history' -- what are the facts, and to how
many decimal places? You pilot always into an unknown future; facts are
your single clue. Get the facts!"
--Lazarus Long

My fear is that the high PSA way sway other factors. Maybe the
pathologist, knowing the PSA, leans more toward a higher Gleason.

======> the gleason score is determined by what the pca cells look like.
a 3 gleason pca cell has a totally difference appearance as compared to
a 4 gleason, which is sort of slimy looking.   so, it's not like
grabbing straws.  all the person has to do is figure out which has the
most cells of that gleason.   and look at how they do WBC counts.  they
measure an area and count the cells, then multiply that to come up with
the total.   so, the readings from another lab should be close to the
original ..... if they are using the same technique.

---------

Then, if I choose surgery, perhaps the surgeon sees the Gleason and the
PSA and figures I'm a high risk patient. He may get more aggressive when
he's cutting near the nerves.

======> doesn't  work that work.  the surgeon won't know until he gets
inside as to how much needs to be removed.   each case is different.
each patient's cancer has grown a different way, with a general path it
takes.   the nerves give off an enzyme when they fire that is like a
dinner bell to the pca.  that is why, if the cancer can make it out of
the prostate gland, will go to the nerves first and wrap themselves
around the nerves, which is why the surgeon has to remove the nerve.

again, it's something he won't know until he gets in there.  if the
nerves are in good shape, when he removed the gland - then the gland
tissue just slide down and falls off of the nerve like a it does on a
piece of chicken meat.  nice and clean.    if the pca has just started
to attack the nerve,  it is sticky and the surgeon can peel off the
flakes of pca.   if the pca is stuck and surrounded the nerve, the
prostate tissue is bonded to the nerve - then the surgeon has no choice.

here's a case - by example - two patients.  both with approximate same
psa and gleason and age.  same surgeon, same hospital staff and
operating room.  six months apart.  i was able to have nerve sparing,
the other patient wasn't.

-------------

The outcome might be much worse side effects than a lower PSA might have
warranted.
Does this make sense? Or am I just totally paranoid?

======> right now,  you got a hell of blow and you're reeling.   and you
have to consider ALL your options.   regardless of what that option is,
you are the final person to have the say and as my surgeon told me,
"your life will never be the same"

those words have burnt into my mind ever since.   my life has not been
the same, but it isn't been terrible either.   i had prostate cancer and
i'm a survivor.  i can't ignore that fact.  the cancer is a beast and
you have to fight the beast..... today, tomorrow and in the future, so,
your life will never be the same for that reason.

did the doctor put you on a two week antibiotic treatment like cipro or
levaquin?  this would remove the prostatitis factor and infection and
give you a better psa reading and a closer picture as where you real psa
reading is.  

right now,  your 20.3 is a total of your pca and any other factors you
might have, such as infections, prostate stones - (because they are a
source of re-infection) and anything that could be in the urinary tract
that could cause a rise in the psa.  

hope this info helps.

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc

I think you are worrying too much.  I doubt strongly that the
pathologist was influenced by the PSA when making his judgement about
the Gleason scores.  There is a good chance he didn't even know what it
was.  I am not a surgeon, but it is my impression that surgeons decide
on how to proceed on the basis of what they see when they opene you up.
 If you are concerned about the PSA affecting how the surgery is done,
talk to your doctors.  Also, as others have pointed out, retesting is
not likely to show a PSA less than 10, which is a common dividing point.

I think you are trying to control your fate, which is quite natural.  It
is scary to have to put yourself in the hands of other people, who may
be fallible.  I would suggest you relax and try a bit of fatalism.   You
have already done whatever could be expected of you.   If you feel
uncomfortable with your doctors, consider getting other doctors.   But
at some point you are just going to trust that they know what they are
doing and they are aware of these various factors and know how to
balance them.

Good luck!

Let me add one other bit of advice.  You are concentrating on one bit of
information and trying to see how it might affect your treatment.  But
what you don't realize is that through years of training and medical
practice, your doctors know a lot of other things that you know nothing
at all about.   When talking to you, they can't take the time out to
give you a complete medical education, so they have to oversimplify.
On the basis of the oversimplified version that you, a layman, can
follow, it is foolhardy to try to draw conclusions about what will or
will not happen.

I don't say this to belittle you because I know that I have done the
same thing in the past and I continue to do it today.  I remember once
worrying about something and my doctor just saying "it doesn't happen
that way".   That is a principle to keep in mind.  Whatever you think
now, it probably just doesn't happen that way.  It makes sense to ask
your doctors about anything you may have doubts about, but after that
let go.  Otherwise you are going to obsess about fantasies.  I know,
again from personal experience, that it is very hard not to do that, but
it is basically a waste of time.