New diagnosis of Gleason 6

User

Posted 17 Jun 2025 at 09:58

Hello everyone,I’ve recently had my diagnosis through biopsy.
I’ve had a few episodes of very mild ED and general tiredness so GP followed up with DRE mpMRI which showed a lesion

My Gleason is 6, my PSA is 0.6 so at the moment AS is being advised.As you know I’ll be having regular PSA tests, my concern is my PSA has never indicated a problem, has anyone else had this with it being so low?

Still to decide if AS is for me,as I’m 56 and I’m feeling it’s maybe best to get treated now

User

Posted 18 Jun 2025 at 14:47

Thanks Adrian,interesting video

User

Posted 22 Jun 2025 at 06:38

Hi Matt

Sorry to hear about the diagnosis. It’s a bit of a rollercoaster ride and takes about a week to get your head round it.

I went through the similar journey back in September/October 2019.

Once my mind had settled, I got an action plan together. First to investigate how much risk can be associated With G6 prostate cancer as I’ve seen the vibes playing it down and my local team were similarly very optimistic.

I decided to go back to the core science research on what cancer actually is and looked at well respected work done by leading pathologists in the industry. It became very apparent from their work that G6 cancer exhibits all the traits that defines a cancer and although lower risk is still capable of metastasis.

This was enough evidence for me and I decided to get the cancer removed while it was early stage….. and at best estimates, localised.

I moved to take a second opinion from a leading and very well respected consultant urologist professor.

It was pointed out that in around 44% of cases post histology results show cancer upgraded. Here is a link to a research paper to support this:

https://bmcurol.biomedcentral.com/articles/10.1186/s12894-019-0526-9

It turned out post surgery histology that my strategy of avoiding AS and moving to an interventional approach paid off massive dividends as indeed the cancer was upgraded and was more extensive than depicted on scans. Final classification was T2C. It was thought it was a very short time period from going T3 😵‍💫

fundamentally the longer a cancer is left in situ the more chance it has to migrate

I’m now about 5 1/2 years since treatment and still undetectable. But be mindful in this game cancer can return a significant time after initial diagnosis due to micro micromets. My view is by acting early I give myself a higher probability of a good outcome and remain optimistic

Hope this helps and adds some clarity.

Cheers

simon

Edited by member 22 Jun 2025 at 06:43 | Reason: Not specified

User

Posted 22 Jun 2025 at 08:07

Originally Posted by: Online Community Member

It was pointed out that in around 44% of cases post histology results show cancer upgraded. Here is a link to a research paper to support this:

https://bmcurol.biomedcentral.com/articles/10.1186/s12894-019-0526-9

Hi Simon.

When AS is ever mentioned as a treatment option, you usually post your story and the same link to the inaccuracies of Gleason scores and how they are often upgraded after surgery.

In the report you cited, it explains why the low risk cancer group, which includes a very high percentage of Gleason 6 (3+3), appears to be particularly prone to upgrading and goes on to give reasons why.

[In this cohort of 17,598 patients we found overall upgrade and downgrade rates of 25.5 and 15.6% respectively. Interestingly upgrade rate was highest in those patients undergoing RP for low risk prostate cancer, as classified using D’Amico criteria that are widely used in UK practice [25]. Whilst this is somewhat expected given that this group comprises patients with Gleason 3 + 3 = 6 disease on initial biopsy, for whom the only change in grade can be upgrading, the rate of 55.7% is higher than reported in other comparable series. Whilst this may have implications for counselling men with low risk disease that are considering surveillance, we must be wary not to extrapolate this figure to all patients. In the UK, recent years have seen a reduction in the number of men with low risk disease that undergo radical treatment [14], which is reflected within our cohort (n = 1766; 10%). This means those patients with low risk disease that undergo RP are likely to have other ‘high risk’ features, suchIn this cohort of 17,598 patients we found overall upgrade and downgrade rates of 25.5 and 15.6% respectively. Interestingly upgrade rate was highest in those patients undergoing RP for low risk prostate cancer, as classified using D’Amico criteria that are widely used in UK practice [25]. Whilst this is somewhat expected given that this group comprises patients with Gleason 3 + 3 = 6 disease on initial biopsy, for whom the only change in grade can be upgrading, the rate of 55.7% is higher than reported in other comparable series. Whilst this may have implications for counselling men with low risk disease that are considering surveillance, we must be wary not to extrapolate this figure to all patients. In the UK, recent years have seen a reduction in the number of men with low risk disease that undergo radical treatment [14], which is reflected within our cohort (n = 1766; 10%). This means those patients with low risk disease that undergo RP are likely to have other ‘high risk’ features, such as large volume tumour.

This study also demonstrated a reduction in upgrading in more recent years, with the rate falling from 30.6% in 2011 to 23.2% in 2016. as large volume tumour.]

Unlike, yourself, I went on active surveillance and it failed miserably. Read my profile and you'll see what a precarious position it left me in. I have far more reason than most to warn others of the possible dangers of this treatment. However, I don't think it's helpful, by using a personal experience, to frighten people from AS, when it's such a good and unintrusive treatment for the majority of men with low grade prostate confined cancer.

It is increasingly becoming a chosen option for men meeting AS criteria.

https://www.cancer.gov/news-events/cancer-currents-blog/2022/prostate-cancer-active-surveillance-increasing

I think we'll always agree to disagree on the merits of AS, mate. 🙂

Edited by member 22 Jun 2025 at 11:39 | Reason: Typo

User

Posted 24 Jun 2025 at 11:15

On the question of whether Gleason 6 ever becomes metastatic, my impression is in line with Adrian’s i.e. that this happens very rarely and quite possibly never.

As far as AS is concerned, however, it seems to me that the much more important question is to try and be as sure as possible that the cancer really is Gleason 6, (or Gleason 3+4 with ideally only a small amount of 4) and then also to maintain vigilance because there is always a risk of a new and more aggressive cancer developing as long as you still have a prostate.

As discussed in another thread, the accuracy of MRIs and PSMA PET scans has improved tremendously in recent years. We are not yet at the point where these tools can diagnose a cancer with 100% accuracy without the need for a biopsy, but I hope that we might get there before too long.

This does, however, make me wonder whether some of the historical statistics on AS, encouraging as they already are (in my view), may even be a bit pessimistic. The reason I say this is that many of the men involved in earlier studies will have been diagnosed at a time when scans were less accurate and, by the same token, biopsies were either random or less well targeted than they are now.

What I hope this means is that there are fewer and fewer men being put on AS when this is not appropriate for them. It should also mean that if it turns out that somebody on AS does eventually need treatment, this will be picked up in a more timely and accurate manner in the future than it may sometimes have been in the past.

One final point – we often point out that, although this site is great in may ways, it does suffer from the weakness that the sample of experiences is biased towards the bad end of the spectrum. This is likely to be particularly true of AS because most of the men for whom AS works well are simply getting on with their lives and will not be going on a site like this.

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User

Posted 17 Jun 2025 at 21:43

Matt, assuming your Gleason 6 is 3+3, from what I read there is a fair likelihood that it may not develop further. Obviously you should do your own reading and talk to your own doctors, but any treatment brings side effects and you really don't want those if it isn't necessary.

The benefit of AS is that the situation is being monitored so that as long as nothing changes you stay untreated and avoid those side effects, but at the same time any adverse change will be picked up quickly and action can be taken.

In the end though it is your choice, and some men struggle to carry on with the knowledge there is the potential for a cancer developing within them even if there is no current problem. But do read about the side effects of the various treatments, and think how you would cope with those, before deciding. (And also read the experiences of other men on this forum, those are really helpful in making sense of what different treatments are really like).

User

Posted 18 Jun 2025 at 03:17

Hi Matt.

I'm sorry that you've had to join the club but welcome to the forum.

If your biopsy is accurate, you appear to have low grade PCa, and if it's safely contained within in the prostate, you seem to be an ideal candidate for AS.

If you see my profile, you'll see that my AS failed, but it's an excellent treatment option for the majority of men. My only advice would be, ensure that the AS is active and monitored correctly, with regular follow up PSA checks and scans.

Here's a link to Dr Scholz's opinion of Gleason 6 PCa. In it he states that he doesn't even class it as 'cancer' Generally, the lower your PSA, the better.

https://youtu.be/a0sjUallZQU?si=lMLdMJ3PxV5GA_uX

Best of luck mate. 👍

Edited by member 18 Jun 2025 at 04:03 | Reason: Additional text

User

Posted 18 Jun 2025 at 11:47

Hi Matt

My situation is similar to yours.

I was diagnosed in March with Gleason 6 and a PSA of 1.47 at 57 years old and no symptoms. Basically a DRE done at a Bupa health assessment in December picked up something suspicious which triggered an MRI which showed what was felt at the DRE was actually nothing serious but showed a small lesion the other side of the prostate which was later biopsied as Gleason 6. It took me several weeks to come to terms with Active Surveillance as my natural reaction was that I just wanted it out, but after speaking with nurses from PCUK and Macmillan and joining PCUK's monthly AS call a couple of times and several forums/Facebook groups, I came to the conclusion that anything other than AS would at the moment be over treatment. A nurse I spoke to mentioned it would have taken years to have triggered any investigation on the NHS as my PSA is good (yours is even better) and it may be many years before I need any treatment (if ever), but at least I'm now being monitored probably 7 to 10 years earlier than I would have been with ONLY PSA testing every year or two. I have done a lot of research and started taking vitamin D3/K2 daily and drinking Green Tea and Ginger & Turmeric tea as some individuals have reported these have helped and my consultant's approach was they won't do me any harm. I was already taking probiotics and high strength Korean Ginseng before diagnosis. I Just had my first 3 month PSA test a week or so ago so will get and have a routine phone consultation on Friday to discuss the results.

User

Posted 18 Jun 2025 at 14:47

Thanks Adrian,interesting video

User

Posted 18 Jun 2025 at 14:49

Thanks mate, I’ll hopefully be seeing a Consultant in the next 3 months so I think I’ll have a better idea after that.

User

Posted 19 Jun 2025 at 15:06

For G6 or G7 where AS is offered it comes down to if you can cope with the uncertainty of continued testing or take the risks that treatment brings with it. Its not an easy choice, some here have done well on AS some not and others (like me) opted for treatment. Take your time, research the heck out of it and then see where your head is.

Good luck

User

Posted 19 Jun 2025 at 15:14

Thanks mate, yeah all I seem to be doing is researching PC at the moment.I’ve a few weeks before I see the consultant so I’ll keep looking online!

User

Posted 19 Jun 2025 at 15:14

What treatment did you go for?

User

Posted 22 Jun 2025 at 06:38

Hi Matt

Sorry to hear about the diagnosis. It’s a bit of a rollercoaster ride and takes about a week to get your head round it.

I went through the similar journey back in September/October 2019.

This was enough evidence for me and I decided to get the cancer removed while it was early stage….. and at best estimates, localised.

I moved to take a second opinion from a leading and very well respected consultant urologist professor.

It was pointed out that in around 44% of cases post histology results show cancer upgraded. Here is a link to a research paper to support this:

https://bmcurol.biomedcentral.com/articles/10.1186/s12894-019-0526-9

fundamentally the longer a cancer is left in situ the more chance it has to migrate

Hope this helps and adds some clarity.

Cheers

simon

Edited by member 22 Jun 2025 at 06:43 | Reason: Not specified

User

Posted 22 Jun 2025 at 08:07

Originally Posted by: Online Community Member

It was pointed out that in around 44% of cases post histology results show cancer upgraded. Here is a link to a research paper to support this:

https://bmcurol.biomedcentral.com/articles/10.1186/s12894-019-0526-9

Hi Simon.

When AS is ever mentioned as a treatment option, you usually post your story and the same link to the inaccuracies of Gleason scores and how they are often upgraded after surgery.

This study also demonstrated a reduction in upgrading in more recent years, with the rate falling from 30.6% in 2011 to 23.2% in 2016. as large volume tumour.]

It is increasingly becoming a chosen option for men meeting AS criteria.

https://www.cancer.gov/news-events/cancer-currents-blog/2022/prostate-cancer-active-surveillance-increasing

I think we'll always agree to disagree on the merits of AS, mate. 🙂

Edited by member 22 Jun 2025 at 11:39 | Reason: Typo

User

Posted 24 Jun 2025 at 09:43

Hi Adrian

It’s important to give everyone all the available facts, especially when there’s scientific evidence to back them up. This way, people can make better decisions.

We addressed the most of your points ref upgrades back in March. Please refer to the following link for further reference:

https://community.prostatecanceruk.org/posts/t31474-Neurosafe-Technique-or-Retzius-Sparring-Technique

Prostate cancer is a complex and emotionally challenging journey. It is crucial to understand that even a low-grade G6 prostate cancer can metastasise to other parts of the body, although this occurrence is less likely.

https://blogs.scientificamerican.com/guest-blog/the-hallmarks-of-cancer-6-tissue-invasion-and-metastasis/

Like all cancers, the longer it remains untreated, the higher the risk of spread, as prostate cancer is fundamentally a metastatic and multifocal disease. If this risk is tolerable, AS may be considered an appropriate treatment option.

All the best

Simon

Edited by member 24 Jun 2025 at 09:49 | Reason: Not specified

User

Posted 24 Jun 2025 at 10:31

Originally Posted by: Online Community Member

Like all cancers, the longer it remains untreated, the higher the risk of spread, as prostate cancer is fundamentally a metastatic and multifocal disease.

Hi Simon.

I'm sorry, mate, but that's simply incorrect.

Dr Scholz shows that there was no metastatic disease, in the full cohort of 26,000 men with 'pure' Gleason 6(3+3).

https://youtu.be/NV8QHzbgamI?si=ZUkUsFVLJsE895Wy

You mentioned that you turned to scientific core to make your decision. Both the scientific links you keep quoting are questionable. One is from an old blog in 2013 and the other is about upgrades of Gleason scores following prostatectomy which casts serious doubts on its own findings in relation to low grade cancer.

I accept biopsies my still be inaccurate and some Gleason 6 will actually be higher, but that's a different discussion altogether.

All the best Adrian.

Edited by member 24 Jun 2025 at 11:15 | Reason: Typo

User

Posted 24 Jun 2025 at 11:15

On the question of whether Gleason 6 ever becomes metastatic, my impression is in line with Adrian’s i.e. that this happens very rarely and quite possibly never.

User

Posted 24 Jun 2025 at 12:26

Hi Guys

Totally agree, which is why i've always been very careful and stipulated that although G6 has all the traits of a cancer cell although its less likely to migrate at this stage.

Reviewing pathologist/microbiologist papers & perspectives was a turning point for me and a blessing as I'd evidently had G7 brewing under the radar.

In most cases I suspect it is small amounts of G7 that are being missed during diagnostics (as was my case). The small amounts of G7 (3+4) I had were close to breaking out of the prostate capsule. I asked why the tumours appear to favour the anterior of the prostate but its not clearly understood.

Adrian what time frame did you get upgraded from G6 to G9?

The blog i posted was old but the science still stands as its fairly basic cell pathology and one of the best written. Authors details: Buddhini Samarasinghe

Here is an interesting discussion with Prof ME from UCLH. He talks about biopsy and how its sets up an environment for cancer spread: https://www.youtube.com/watch?v=0toibiLXRjs&t=1455s

There certainly isn't enough new data out there. The study I referenced is one of the biggest available datasets currently available. The 'low grade (G6)' sample is relatively small (n = 1766; 10%). This study is referenced by a number of the UKs leading urologists.

If you have newer study info please share as I'm always hungry for data.

Cheers

Simon

User

Posted 24 Jun 2025 at 14:14

Originally Posted by: Online Community Member

Adrian what time frame did you get upgraded from G6 to G9?

Hi again Simon.

In Dec 2020, my first TRUS biopsy was 14 cores, only two cores, one in each lobe were positive, only 5% and 10% cancerous, Gleason 6(3+3). Both safely contained within the prostate. The consultant told me how lucky I was, most clinicians didn't class it as cancer.

Only 20 months, later a follow up MRI, this time a LATP uner GA, which was 14 months later than it should have been, showed significant disease progression, 20 out of 24 cores cancerous 40-50%, a combination of Gleasons 3+4, 4+3, 4+4, and 3+5 in the targeted areas. Overall grading Gleason 8 (3+5). Capsule breached, T3a with extraprostatic extension.

Was angry and confused why this had happened.

Almost 4 months later I had RARP, my post op histology confirmed T3a staging, Gleason was upped to 9 (4+5)

It transpired that the most likely cause of this 'apparent speedy disease progression' was that the first biopsy had been inaccurate and had missed all the more aggressive cancer cells.

As I have said many times before, if anyone has cause to question AS as a treatment option, it should be me. However, mistakes were made in my AS, and I assess the value of AS as a whole, not based on my personal experience.

I'm a great believer in if it's not broken, why fix it. Pure Gleason 6 (3+3) is not broken, so why on earth, risk all the side effects of radical treatments, when they may never be needed.

You can't dispute the facts, mate. IF, and it is a big if, you're biopsy shows safely contained 'pure, Gleason 6(3+3), active surveillance is the place to start.

Whilst on AS you must then ensure that all the PSA checks and follow up scans, are done in a timely fashion. I appreciate why some, who believe cancer's cancer, no matter what it's Gleason score, would reject AS. They would find it too worrying.

Edited by member 24 Jun 2025 at 14:23 | Reason: Typo

User

Posted 24 Jun 2025 at 18:26

Hi Adrian

That is quite shocking.

I was very much in a similar place Q4 2019. 3T MRI pirads 4. TPM 24 cores samples with a few showing G6 in all four quadrants. Local team no urgency and AS recommended. This was echoed by the London based MDT.

Out of due diligence I got a second opinion. The prof told me with my biopsy diagnosis its likely ~60% chance of post histology upgrade. Post histology results showed much more extensive spread than had been depicted by diagnostics. It was pretty much a knife edge decision to act as I was tempted to push it out until after xmas into 2020.

Long may our 'undetectable' bloods continue.

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