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Gleason 6 Gland Boundary
Active surveillance for 5 years with 6 month PSA and annual MRI. PSA hovering around 5.1. Two biopsies showing Gleason 6. The tumor seems to exhibit slow expansion with pressure on the gland boundary. Has anyone had experience with Gleason 6 escaping the prostate?
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Never heard of a Gleeson Six doing that, but, They only get about 1% of the prostate when they do a biopsy. It is not unusual for somebody with a 3+4 to find out after surgery that they had a higher Gleason score. In my case, it was a 4+3 after surgery, I know people that had 4+5.
It is possible they missed some things that are aggressive. Have you had an MRI? That can tell whether or not there are lesions that are more suspicious than Gleeson 6.
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1 Reaction@jeffmarc Thanks Jeff. Yes, been watching it on annual MRIs and according to the reading it's a bit inconclusive but sitting on the boundary. It's been 4 years since my last biopsy, so sorting through whether that's the next step to see if I get a different score.
Besides PSA tests and annual MRIs, what other tests are you doing to have confidence it’s a “true” Gleason 6?
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1 Reaction@brianjarvis
Got my decipher score a while back, and genetic testing. Pursuing a second opinion on pathology now, but haven't achieved it yet. Probably should be contemplating a follow up biopsy. Anything I've missed?
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1 Reaction@rport3 There are a number of tests that can be checked while on active surveillance to give additional insight into the status of the disease:
> Standard PSA test. (But, preferably a PSE test. This Prostate Screening EpiSwitch test is significantly more accurate than the standard PSA test for detecting prostate cancer.)
> % Free PSA (While your PSA is between 4.0-10.0)
> PSA Doubling Time
> PSA Velocity
> PSA Density
Consider another biomarker test besides Decipher, one that will provide additional relevant information. There are many different tests depending on what you’re looking for:
> FoundationOne®Liquid CDx; Guardant360; Caris Assure.
> Prolaris; OncotypeDx.
Liquid biomarker tests:
> (blood): 4KScore; EpiSwitch PSE; Phi Prostate Health Index;
> (urine): SelectMDx; PCa3 (PC Antigen 3); MyProstateScore (MPS), ExoDx.
(I’ve probably missed others.)
What you want to do is to monitor to ensure you have a “true” Gleason 6. Those don’t metastasize. (https://youtu.be/NV8QHzbgamI)
With that amount of “active” surveillance, the status of the disease can be closely monitored - you’ll know if anything changes as soon as it changes.
I would recommend another biopsy.
September 2025, my 1st biopsy. 5 cores of 3+3.
Since lesion was Pirads5 and along capsule wall with possible ECE, repeat biopsy was completed April 2026. 5 positive cores with (4) cores of 3+4. One core was 100% cancer with 40% grade 4.
As others indicated biopsy sampling-rate is small. I pushed for the repeat biopsy due to Pirads5 lesion (2cm long) along or in contact with wall.
My PSA has only tested above 2.8 twice. Once a 3.5 and once a 4.0. Have had mulitple PSA tests over the past 9 months at 2.0.
Because of the 3+4 and lesion along wall, I have scheduled surgery.
No exact path/guidelines. Try to obtain as much info as possible. I recommend scheduling a repeat biopsy ASAP. Especially, since it has been 4 years.
You may want to do biopsy with 16 plus grid cores (plus amy targeted cores), to have more sampling data.
Best Wishes.
Thank you! Great information