Gleason 6.....but decreasing PSA

Hi John.
As far as I am aware it's almost impossible to define when one has small cell PCa, that is by MRI scans. Whether it can be established via a biopsy I am unsure also, it may be possible that Small Cell has different markers from other PCa,s. As you apparently were diagnosed about a year ago and now if you do not have other symptoms it may well suggest that it's not Small Cell, as that PCa is very aggressive tumour and would manifest other symptoms by now.
It's a question I suggest you should direct to your Urologist at an early date to put your mind at ease.
What was your initial PSA result prior to diagnosis plus what treatment are you currently on if any.
Larry

John, do you still have your diagnosis letter? All likelihood is that it says on there what kind of prostate cancer you have - probably adenocarcinoma. If the letter doesn't say, just ask your Gp or nurse to check the biopsy results for you.

Small Cell cancer is very rare and presents as aggressively attacking bone whilst refusing to respond to hormone treatment. It wouldn't show itself as a G6 and they would not have allowed you to opt for active surveillance. Occasionally there are people who start off with adenocarcinoma or one of the other 26 types of prostate cancer and then Small Cell is also diagnosed later (Mrstommofire's husband for example) but you are not showing any indicators of this as your scans are clear.

My last biopsy in 2015 showed no change in diagnosis, nor did MRI scans in 2018 and early 2019.

The urology consultant has said there is no clinical need for a further biopsy and that my low grade disease will never cause me any issues; however he did say in an appointment meeting with my wife and I in early 2019 that he would be prepared to book me in for a biopsy simply to "cover his back" (his own words) in the unlikely event I moved elsewhere and another urologist found some advancement.

I declined the biopsy (because of his advice on there being no clinical need) and I have been discharged from the Active Surveillance programme and thus have no "safety net".

I remain concerned that I have untreated prostate cancer, albeit hopefully still at a low grade.

What should I do?

Because of certain similarities between your situation and my own early circumstances I would suggest you ask to stay on AS, with annual MRI scans thrown in.  Just my own personal opinion based on my own experience of course.