1. < Prostate Cancer

Gleason 6 (3+3) treatments

Posted by joe1 @joe1, May 21 3:39pm

Hi,
I had a biopsy and it came back with Gleason 6 (3+3). The urologist first told me it was extremely important that I have a biopsy done every 12 - 18 months to monitor this. 3 years later with no followups and now he's telling me we will just do MRI's instead (I also have ulcerative colitis so biopsy is extra painful). He also told me my cancer is nothing and don't worry about it. Problem is, he's told me a lot of things and then told me the exact opposite, so I'm not sure if I trust him.

Question for others with Gleason 6 ....... what type of treatment/monitoring are you being treated with?

Thanks

Joe

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ecurb | @ecurb | Jul 17 8:55am
In reply to @kugrad1975 "Sorry to disagree with you, but I am not going on that sh__ ADT Unless absolutely..." + (show)
@kugrad1975

Sorry to disagree with you, but I am not going on that sh__ ADT Unless absolutely necessary, as I have read and heard of too many stories of deleterious side effects. I am comfortable with the recommendations of both my urologist and radiation oncologist that no treatment is needed at this time, and to stay on Active Surveillance. My challenge is no one seems to be able to explain to me my last Biopsy results in relationship to previous diagnosis,

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Never heard of the decipher test, glad your numbers are low. Means you may have a lot of time to watch these cancers cells . I have the opposite of you, fast growing, less than a year, Gleason 9-10 on 13 biopsy’s. Agent Orange did me in. Metasticized to pelvic lymph nodes. So ADT was a must. 18 months now, only side effect is sleepiness. No pain. Ttyl.

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clandeboye1 | @clandeboye1 | Jul 17 6:54pm
In reply to @kugrad1975 "Dear Clandeboye1 Yes I have had the Decipher Test. Decipher Test is used to determine risk..." + (show)
@kugrad1975

Dear Clandeboye1 Yes I have had the Decipher Test. Decipher Test is used to determine risk of metastasis. On a scale of 1-100, with 1 being the least risk and 100 being the highest risk, my score was .12 which is very low risk.

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I love how YOU are taking control of your health .

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clandeboye1 | @clandeboye1 | Jul 18 4:14pm
In reply to @richardblackman "Joe, I have two friends with Gleason 3/3 they've had for close to 10 years and..." + (show)
@richardblackman

Joe,
I have two friends with Gleason 3/3 they've had for close to 10 years and are under active surveillance. Close watch of their PSA and an MRI every couple years is their "treatment." According to their doctors, they may never need additional treatment. I had similar for 2 years, but when my PSA rose, the doc found something suspicious in a digital rectal exam, then the biopsy showed a 3/4 Gleason. That's when they said I needed treatment so had a prostatectomy (3 years later). PSA still at zero and no complaints

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Your friends on AS with Gleason 3 + 3 How many Biopsy cores were positive out of how many taken ?

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1 reply
clandeboye1 | @clandeboye1 | Jul 18 4:44pm
In reply to @kugrad1975 "Dear Clandeboye1 Yes I have had the Decipher Test. Decipher Test is used to determine risk..." + (show)
@kugrad1975

Dear Clandeboye1 Yes I have had the Decipher Test. Decipher Test is used to determine risk of metastasis. On a scale of 1-100, with 1 being the least risk and 100 being the highest risk, my score was .12 which is very low risk.

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Per Dr. Walsh's book the Prostate Pathology analysis is the most difficult and requires a pathologist with hundreds if not thousants of tests in his resume .
With 3 +3 = 6 considered by some ( not me ) as "NOT CANCER " I can imagine the pathologist erring both ways , given it's marginal . NO IT'S BENIGN or YES IT'S Gleason 6 Low grade .

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richardB | @richardblackman | Jul 18 4:58pm
In reply to @clandeboye1 "Your friends on AS with Gleason 3 + 3 How many Biopsy cores were positive out..." + (show)
@clandeboye1

Your friends on AS with Gleason 3 + 3 How many Biopsy cores were positive out of how many taken ?

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Clandeboye1,
Don't know the answers, but they've been monitored closely for all the years.

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1 reply
clandeboye1 | @clandeboye1 | Jul 18 6:05pm
In reply to @richardblackman "Clandeboye1, Don't know the answers, but they've been monitored closely for all the years." + (show)
@richardblackman

Clandeboye1,
Don't know the answers, but they've been monitored closely for all the years.

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What age group were they in when digonosed ? & What age now ?

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clandeboye1 | @clandeboye1 | Jul 19 9:49am
In reply to @jasonfarmer "Second option is what I would do. I was also 3+3 =6 with biopsy and mri..." + (show)
@jasonfarmer

Second option is what I would do. I was also 3+3 =6 with biopsy and mri I chose prostatectomy (surgery) . Father had prostate cancer at 52 , I was 58 @1 year ago. Turns out good decision, I was actually 3+4=7 and high risk 93% according to dicipher test. Presently cancer free undetectable psa . I hope all goes well for you.

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It's common for a Pathologist to upgrade the Gleason Score on a removed prostate

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1 reply
brianjarvis | @brianjarvis | Jul 20 8:19am
In reply to @clandeboye1 "It's common for a Pathologist to upgrade the Gleason Score on a removed prostate" + (show)
@clandeboye1

It's common for a Pathologist to upgrade the Gleason Score on a removed prostate

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Actually, various studies between 2008 - 2023 indicate that initial grade and pathological grade match between 50%-60% of the time, and upgraded between 25%-30% of the time.

Here is one of those studies, where they found that Gleason scores were the same in 50% of cases, downgraded in 26%, and upgraded in 24% (https://pubmed.ncbi.nlm.nih.gov/35972023/).

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1 reply
clandeboye1 | @clandeboye1 | Jul 20 9:24am
In reply to @brianjarvis "Actually, various studies between 2008 - 2023 indicate that initial grade and pathological grade match between..." + (show)
@brianjarvis

Actually, various studies between 2008 - 2023 indicate that initial grade and pathological grade match between 50%-60% of the time, and upgraded between 25%-30% of the time.

Here is one of those studies, where they found that Gleason scores were the same in 50% of cases, downgraded in 26%, and upgraded in 24% (https://pubmed.ncbi.nlm.nih.gov/35972023/).

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Brian ,
I am familiar with these studies .
My point being , your Gleason score may be higher than your Biopsy report . If you are all 3+3=6 there may be some 4 in there which shines a different light on your treatment options . In such a case , I recommend a 2nd Biopsy opinion .
See Pages 112 & 113 of Dr. Walshs book " Biopsy - Why you should get a 2nd opinion "
Thanks for your response .

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1 reply
brianjarvis | @brianjarvis | Jul 20 9:39am
In reply to @clandeboye1 "Brian , I am familiar with these studies . My point being , your Gleason score..." + (show)
@clandeboye1

Brian ,
I am familiar with these studies .
My point being , your Gleason score may be higher than your Biopsy report . If you are all 3+3=6 there may be some 4 in there which shines a different light on your treatment options . In such a case , I recommend a 2nd Biopsy opinion .
See Pages 112 & 113 of Dr. Walshs book " Biopsy - Why you should get a 2nd opinion "
Thanks for your response .

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As those studies show, pathological grade usually stays the same as needle-biopsy or is downgraded. Sometimes yes, it is upgraded. If there is concern of something more serious lurking unseen, there are no less than a half-dozen other non-intrusive tests and calculations that can be done to estimate this rather than getting a prostatectomy just to find out.

Yes, 2nd opinions can be valuable (I’ve had two). But, I fully understand that much of the interpretation of images, scans, and slides is often as much an art as it is a science and dependent on the skill and experience of whoever is doing the reading. It’s good to have an independent set of eyes reviewing images, scans, or biopsies. But even then, there is no guarantee that that’s what it really is. Such is life….

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