@charlesprestridge (2) When properly phrased, what will be said is that a “true” Gleason 6(3+3) is not a cancer and that it doesn’t metastasize.
> https://youtu.be/NV8QHzbgamI

The next question (of course) is what is a “true” 3+3 and not a 3+3 with something more insidious lurking unseen?

There are two ways to do this:
> One is to simply cut it out (prostatectomy) and then see if the pathology warranted the radical treatment. (What other disease, illness, or injury do we do that with - amputate first, and then figure out later whether or not we should have?)

> The other is with active surveillance. That’s where keeping active surveillance truly “active” comes in. As with any other disease, the goal is to only seek active treatment when treatment becomes medically necessary (otherwise we’d be amputating every appendage or organ with every scratch, bump or bruise). Prostate cancer is no different.

For active surveillance, In addition to regular Total PSA testing, also track:
> % Free PSA
> PSA Doubling Time
> PSA Velocity
> MRI results
> PSA Density
> Biopsy results
> Biomarker (genomic) tests (there are at least a dozen of them)
> Genetic (germline) tests
> Bone/CT/PSMA scan results
> (in addition to all the other standard annual health-related tests that are done.)

For a “true” Gleason 6, you’ll be on active surveillance for a long time (or eventually succumb to something else). If not a “true” Gleason 6, by tracking all those markers appropriately, any change in prostate cancer status will be detected in real-time. That delay also buys time to come up with a plan of treatment should a concerning change ever occur. Then if/when necessary, actively treat.

(In my case, I used that time to thoroughly research and selected Proton radiation as my choice of treatment.)
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