Under what circumstances is it OK to treat Gleason 6 ?

I've told this story before, but I had 3 MRIs and 3 biopsies during the 8 years I was on AS. All said Gleason 6. Genetic test said low risk. PSA kept rising and when it got to 16 we did the surgery. Pathology came back 3+5 for a Gleason 8. So for me even though we were pretty sure it was Gleason 6, the rising PSA convinced the doc to take it out. Good thing we did.

Interesting…..i have 2 friends who had treatment with a Gleason 6, one has considerable regret.

So, you weren’t a true 6 then, you were an 8 in 6’s clothing. Perhaps any Gleason 6 should only treat when PSA levels rise consistently over time.

I was a 7 with a rising PSA over 6 years from 6 to 17 and have now opted for treatment. I feel I probably could have waited until my PSA got to 30 or so but the stress associated with that wasn’t worth it personally.

My understanding is that a diagnosis of Gleason 6 based on biopsy can have missed the lesion or areas of the prostate that are actually Gleason 7 or higher. AS is appropriate with Gleason 6, PSA under 10 and a PSA that is not rising rapidly.

Just my opinion but I think the range should be way wider.

Even 7s could get away with no treatment.

I am 3+4 and happily on active surveillance. February 2023 PSA was 5.49. April 2022 was 4.65. Two lesions found in January pi rad 4. 9mm and 4mm. Doctor I am seeing thinks I can wait . I am going to be 71 in October.

I am on the 4th day after my prostate surgery, I have a long road to recovery, I know, but no regrets, except for not requesting more medication for the 24 hours in hospital. Now home and mostly only on only Tylenol. I was only a 3+3=6, PSA 5.2 but dicipher test was high risk 93 percentile. Surgeon said all looks good he saw no evidence of being outside of gland, no lymph node removed and nerve sparing went well. Time will tell for sure but hopefully this is a cancer free 59 year old man with a full recovery. If not, I will deal with it as it comes. Catheter is hard to deal with. It hit me last night, 2 am I was only 3 day in and 7 more long days to go with this torture device, put tears in my eyes. I will make it and all will be ok. All said No Regrets.

ozelli: others here have stated the point but nobody is able to say definitively that the cancer will not grow and spread in a specific time frame, doctors, prolaris or decipher test, notwithstanding. Your risk is if they are wrong, are you ok with the hormone and chemo therapy choices that impact quality of life that come with it spreading. Those can be long term choices.

Postop recovery will get easier.
Catheter: you will become more comfortable with it. Catheter cleaning videos helpful to avoid infection. I only had large night bag; kept it in a plastic cleaning bucket by my side.
Walked 20 - 30 mins in 5 min stretches around the house.
Kegel exercises after catheter removal. PT helpful to me.
I strictly observed lifting restrictions for 2-3 mos.
You will get better soon.
RP in Aug 2022. 72 yrs old. My surgical recovery was excellent.
Hopefully you will get a great result.

Michael thank you for sharing and your encouragement. I never knew this would have the emotional impact it does on me . Being one who doesn’t usually show emotion my eye have been opened, be it only a few times, but very surprising to me. Back to original post 3+3=6 may not need any action or in my case, action, RP . In 7 days I will have more definitive info (was I just a 6, or is it a higher Gleason) just under rated. I do come from the belief if a sticker is in my hand get it out so it heal and stop hurting. Still no regrets.

For myself, I would not take the chance of leaving a Gleason 6 cancer in my body. Scanning tools (MRI, CT, etc.) and biopsies are good predictive tools, but they are not 100% accurate. With that said, age/health and personal life expectations also need to be taken into account. I am 57 (Gleason score of 7) and had a RP at Mayo-Rochester last fall. Best decision I ever made and so happy to have the cancer out of my body. There is still a chance of bio-chemical reoccurrence, but I feel good that the known cancer has been removed.

Best of luck,

Jim