Prostate Cancer Gleason 6 Group 1 + Hypogonadism

@bobgolf Between the time my original Urologist took me off of Testosterone until the Urologist at Moffit Cancer Centers put me back on, was at least four months. My T levels went down to 51! I couldn't swing a golf club or function normally. I was a mess. This cancer is very slow growing, so we have time. Like you, I will be proactive if and when there is an increase. Statistically, I may be more likely to die of old age before this cancer becomes a real issue. So I too have learned to just live with it.

There must be more than Gleason 6 in your biopsy. The question is, was there something else on your biopsy that made him think you needed surgery rather than active surveillance.

Or is it that the doctor figures you get your prostate removed and go back on testosterone and it’s unlikely you will have prostate cancer pop up. You realize that having surgery will probably Cause major erectile dysfunction problems. Make sure the doctor uses nerve sparing to try to limit it. Surgery can also cause incontinence, though it usually isn’t permanent,

Under normal conditions, you could stop your testosterone treatments and that would result in your being exactly the same as somebody like me who is on ADT. My testosterone has been below 20 for almost all of eight years and actually below five. That allows me to survive with prostate cancer. You can live this way at least you can still get an erection and you don’t have to go through the surgery.

I’m not sure what kind of doctor you are seeing but doing a prostatectomy for a 3+3 is no longer recommended for most situations. Are you working with a center of excellence? It might make sense to get a second opinion before committing to surgery. Why wouldn’t radiation be an option, You should speak to a radiation oncologist. A lot less stress if you get radiation,

I am very similar to you. I am a Gleason 6, diagnosed 3 years ago. My regular urologist at the time of diagnosis said I could continue my TRT that I have been on for probably 7 years. He indicated that if my Gleason score ever got to 8 (metastases) then I would need to stop. At my one year mark I switched to the Mayo Clinic given their reputation being a center of excellence and variety of treatments offered. They did my one year follow up biopsy that again showed some Gleason 6 but nothing higher. Again they said it was okay for me to continue with my TRT. If you think about it, it makes sense that all men on Gleason 6 should be able to continue TRT given those men without hypogonadism and who have regular testosterone numbers are not required to go on ADT once they get Gleason 6 prostate cancer. So why should us men with hypogonadism be required to have very low T while those that produce their own are not required to go on ADT to lower it? You can buy a great book by Dr. Morganthaler on Amazon who has studied the relationship between testosterone and prostate cancer for probably 20 years. He just recently released new findings that support his theories and more and more doctors are accepting the reality that testosterone is not "throwing gas on the fire" of prostate cancer. Indeed I believe it is his theory that Gleason 6 patients do better with high testosterone levels. Another clue your doctor may be off is his suggestion you get your prostate removed when all you have is Gleason 6. Thats sounds like the recommendation that may have been given over 20 years ago. I would recommend you get a second opinion preferably from a Center of Excellence. I will say a prayer all goes well for you.

@bobgolf I will definitely get that book, thank you, and thank you for your prayers. I will pray for you as well. I am under the care of a specialist at Moffit Cancer Center in Tampa since August 2025. As an FYI, my PSA was 7.8 in August 2025 - just before resuming T and starting active surveillance. In February 2026, my PSA level was down to 3.5. Suffice to say that the Urologist at Moffit Cancer Center in Tampa now oversees all of my Urology needs.

I am very similar to you. I am a Gleason 6, diagnosed 3 years ago. My regular urologist at the time of diagnosis said I could continue my TRT that I have been on for probably 7 years. He indicated that if my Gleason score ever got to 8 (metastases) then I would need to stop. At my one year mark I switched to the Mayo Clinic given their reputation being a center of excellence and variety of treatments offered. They did my one year follow up biopsy that again showed some Gleason 6 but nothing higher. Again they said it was okay for me to continue with my TRT. If you think about it, it makes sense that all men on Gleason 6 should be able to continue TRT given those men without hypogonadism and who have regular testosterone numbers are not required to go on ADT once they get Gleason 6 prostate cancer. So why should us men with hypogonadism be required to have very low T while those that produce their own are not required to go on ADT to lower it? You can buy a great book by Dr. Morganthaler on Amazon who has studied the relationship between testosterone and prostate cancer for probably 20 years. He just recently released new findings that support his theories and more and more doctors are accepting the reality that testosterone is not "throwing gas on the fire" of prostate cancer. Indeed I believe it is his theory that Gleason 6 patients do better with high testosterone levels. Another clue your doctor may be off is his suggestion you get your prostate removed when all you have is Gleason 6. Thats sounds like the recommendation that may have been given over 20 years ago. I would recommend you get a second opinion preferably from a Center of Excellence. I will say a prayer all goes well for you.

I am very similar to you. I am a Gleason 6, diagnosed 3 years ago. My regular urologist at the time of diagnosis said I could continue my TRT that I have been on for probably 7 years. He indicated that if my Gleason score ever got to 8 (metastases) then I would need to stop. At my one year mark I switched to the Mayo Clinic given their reputation being a center of excellence and variety of treatments offered. They did my one year follow up biopsy that again showed some Gleason 6 but nothing higher. Again they said it was okay for me to continue with my TRT. If you think about it, it makes sense that all men on Gleason 6 should be able to continue TRT given those men without hypogonadism and who have regular testosterone numbers are not required to go on ADT once they get Gleason 6 prostate cancer. So why should us men with hypogonadism be required to have very low T while those that produce their own are not required to go on ADT to lower it? You can buy a great book by Dr. Morganthaler on Amazon who has studied the relationship between testosterone and prostate cancer for probably 20 years. He just recently released new findings that support his theories and more and more doctors are accepting the reality that testosterone is not "throwing gas on the fire" of prostate cancer. Indeed I believe it is his theory that Gleason 6 patients do better with high testosterone levels. Another clue your doctor may be off is his suggestion you get your prostate removed when all you have is Gleason 6. Thats sounds like the recommendation that may have been given over 20 years ago. I would recommend you get a second opinion preferably from a Center of Excellence. I will say a prayer all goes well for you.

@bobgolf
They want to stop labeling Gleeson Six as cancer
Breaking News: New Study By The Lions of Active Surveillance Says Removing the Cancer Label Could Save Lives
https://howardwolinsky.substack.com/p/what-if-gs6-isnt-really-cancer-new
There are more studies on this issue that I posted already.

I would really question this doctor’s competence. Somebody with a Gleason six should not be treated unless it is really extensive, High number, of cores, high percentage. And even then, treatment is questionable.

14 years ago they stopped testing people for PSA because too many people were being over treated when they had only a Gleason 6. That’s one reason we have a wave of people with very advanced cases these days.

25 years ago, a doctor friend of mine who had a Gleason Six was told he needed to have his prostate out, Searched the whole country for a Doctor Who could do it, Went to the doctor that said he invented it, and he didn’t do it for him, after traveling across the country to be operated on. He had ED for 25 years. Turns out he had an absolutely minimal case of Gleason six, But back, then they were operating on people with it.

I’m not so sure that high testosterone makes sense, But if Gleason six is not prostate cancer, then there’s really no difference between someone with no Gleason and score and someone with a six. The thing is, the areas that show Gleason Six do not actually Get a rise in Gleason score over time, When there is a rise in Gleason score, it is a different spot.

@jeffmarc My prediction is that if Gleason 6 is not cancer than the insurance companies will stop paying for MRIs or biopsies for those on active surveillance with no diagnosed cancer (i.e., 3+3). Sort of like a repeat of the no PSA test recommendation. Need to change NCCN treatment guidelines so insurance companies usually will not pay for RPs or radiation if Group 1 disease.

@jeffmarc My prediction is that if Gleason 6 is not cancer than the insurance companies will stop paying for MRIs or biopsies for those on active surveillance with no diagnosed cancer (i.e., 3+3). Sort of like a repeat of the no PSA test recommendation. Need to change NCCN treatment guidelines so insurance companies usually will not pay for RPs or radiation if Group 1 disease.