Prostate Cancer Gleason 6 Group 1 + Hypogonadism

I was in EXACTLY the same situation as you. I confronted the surgeon and my Urologist with at least six of these early studies. In the end they admitted that “we just don’t really know”. I consulted a third Urologist who is my cousin and is 70 years old. Been in practice a long time. He told me to go to a cancer research center like Mayo, and consult their. I went to Moffit Cancer Center in Tampa and found a urologist who has a whole practice with patients just like you and me. After a confirmatory biopsy, he put me back on testosterone injections (weekly) and put me on active surveillance. He absolutely rejected the idea of me having a prostatectomy. In August 2025 my PSA was 7.8. As of February it was down to 3.5! My doctor was not the least surprised. So I have been on active surveillance and full testosterone placement therapy since August 2025. I’m very happy living my life. I rarely think about this. This urologist by the way he has taken over all of my urology needs. He even prescribes my tadafil.

I highly recommend get multiple opinions and see someone at a cancer research center like Mayo Clinic BEFORE you have a radical prostatectomy.

@floridanad
Gleason six is grade Group one. You are confusing the two measurements which are really meaning the same thing.

There is no such thing as Gleason grade one.

@jeffmarc Gleason grade 1 is from the original system—it describes cancer cells that look almost exactly like normal prostate cells. In practice, pathologists almost never assign it anymore; they rarely use grades 1 or 2 at all.

Grade Group 1 is from the modern system introduced in 2014. It means the lowest-risk category of prostate cancer, corresponding to a Gleason score of 6 (3+3). These are slow-growing, well-formed glands that are much less aggressive.

In short: Gleason grade 1 is an outdated, rarely used microscopic pattern, while Grade Group 1 is the current clinical label for the least concerning prostate cancers—often managed with monitoring rather than treatment. Your report will likely show Grade Group 1, not Gleason grade 1.

@jeffmarc So Gleason 3’s never go on to 4? There have to be cells that go from normal to PIN and then up the chain, no?
Phil

@jeffmarc I have more confidence than you do that the medical establishment (including insurance, CMS) will screw this up. The same studies filled with assumptions were done by the European health services that followed (started?) discouraging PSA tests. The UK experience was a large increase in initial stage 4 diagnosis. A lot of the problem with PSAs (and continuing) is that once the medical establishment demonized these tests and said they were not reliable the patients quit getting them and that is still ongoing to an extent. Once Gleason 6 is not cancer than I expect the patients to treat this as being cleared so no need for surveillance. The insurance companies will probably reinforce this by not paying for any surveillance.

I also suspect the benefits were highly inflated by using old data. Very little Gleason 6 is being treated today compared to a few years ago. Who wants to take the risk of ED and incontinence if the doctor says you can live with this and you will probably die before it advances to the point treatment is required?

@heavyphil
That surprised me too, when I first heard about it. Spots that have certain Gleason scores never change Gleeson. If you have a higher Gleason score, it is in another spot.

Now a pathologist can say what the Gleason is and be wrong, That’s a different situation.

@floridanad
You said
“Gleason grade 1 is from the original system—it describes cancer cells that look almost exactly like normal prostate cells. In practice, pathologists almost never assign it anymore; they rarely use grades 1 or 2 at all.”

I have had prostate cancer for 16 years and I’ve never heard of Gleason grade one. I know people that had treatments 25 years ago and it was never called Gleason grade one it was called Gleason six.

Where did you see this? Even calling it Grade group one is actually pretty recent.

Here is list of reliable sources explaining the difference between the original Gleason grades (including Grade 1) and the modern Grade Groups for prostate cancer from my research:

1. Mayo Clinic - Gleason Score Grading for Prostate Cancer
https://www.mayoclinic.org/diseases-conditions/prostate-cancer/in-depth/gleason-score-grading-for-prostate-cancer/art-20593576

2. Prostate Cancer Foundation (PCF) - Gleason Score and Grade Group
https://www.pcf.org/patient-support/diagnosis/gleason-score/

3. Cancer Research UK - Grade Groups for Prostate Cancer
https://www.cancerresearchuk.org/about-cancer/prostate-cancer/stages/grades

4. Johns Hopkins Pathology - Prostate Cancer Grading System
https://pathology.jhu.edu/urologic/prostate-cancer-grading-system

5. American Cancer Society - Understanding Your Pathology Report: Prostate Cancer
https://www.cancer.org/cancer/diagnosis-staging/tests/pathology-reports/prostate-pathology/prostate-cancer-pathology.html

6. Cleveland Clinic - Gleason Score
https://my.clevelandclinic.org/health/diagnostics/22087-gleason-score

7. ZERO Cancer - Stages & Grading Overview
https://zerocancer.org/stages-and-grading

8. Pathology Outlines - Gleason Grading
https://www.pathologyoutlines.com/topic/prostategrading.html

9. MD Anderson Cancer Center - What is a Gleason Score?
https://www.mdanderson.org/cancerwise/gleason-score-decoded–what-it-means–and-how-it-helps-guide-prostate-cancer-treatment.h00-159854556.html

10. PubMed / Epstein et al. - Contemporary Prostate Cancer Grading System
Key paper on the introduction of Grade Groups (2015/2016).

These are from reputable medical institutions, cancer organizations, and pathology experts. They clearly explain that Gleason grades 1 and 2 are rarely used today, while Grade Group 1 corresponds to Gleason 3+3=6 (the lowest current category).

@floridanad
None of these links show up as links.

UnFortunately, you are too new to post links yet. Made it difficult to look at any of these.

The Mayo link even says this.
The Gleason score and grade group are numbers that tell your healthcare team whether your prostate cancer is growing slowly or quickly. Prostate cancer grades range from 3 to 5. The range starts at 3 because grades 1 and 2 are no longer used.

They are with grade group numbers.

If you’ll check references for Gleason scores these days, you will find Grade group numbers and Gleason scores. I’ve never heard of a doctor at a conference say that a Gleason score is a Gleason grade number, They would say grade group. . It just would be unusual. I’ve been attending conferences at least monthly for many years and do not recall hearing it.

I think you would be hard pressed to find anybody referring to a grade group one as Gleason grade one.

@jeffmarc So what’s your point? These are some of the most prestigious research and medical institutions in the world. Perhaps you should take this up with them and let them know how much you disagree with their use of incorrect nomenclature. It’s not my position to defend.

Additionally. I remember how hard pressed I was to find a Urologist who would agree to put me back on Testosterone injections without thinking it would kill me, and without a radical prostatectomy. But lo and behold, Moffit Cancer Center has such a Urologist, and a large practice of patients in exactly my situation. No other Urologist who I spoke with ever even heard of such a thing. I spent months looking.

With that, I wish you all the best on your quest to find the truth, and I pray that a cure is discovered in our lifetime. God bless.