Does lower grade prostate cancer evolve to more aggressive cancer?

If a decipher test is done and that comes in high it definitely can become aggressive if left untreated.

A gleeson 6 has never been proven to progress however the biopsy may have missed a more aggressive cancer found later so finding what you have is the most important thing. MRI and other tests including a urine test can give clues as to what’s not found

I can only relate my own experience. My first biopsy showed only 1/13 positive cores with a Gleason 3+3, a profile that is debated in the literature as to whether it should even be called cancer.

Two years later, of 9 cores, there was one Gleason 4+4, one 4+3 and one 3+3.

So, did the low grade lesion from the first biopsy evolve to a more aggressive form or were the aggressive lesions there all along and missed? It's hard to say.

Does it matter? If you have a biopsy with a Gleason 3+3 you are more likely to find higher Gleason on a subsequent biopsy than if the first biopsy was all benign tissue. Therefore, active surveillance should be practiced.

A biopsy only gets to about 1% of the prostate. As a result, a lot of different places are missing detection. About 30% of the biopsy Gleason scores are changed after a prostatectomy. I’ve heard From a number of people that have had their Gleason score changed from 3+4 to 4+5. Mine went from 3+4 to 4+3. Occasionally observers will even see people go from a 4+4 or 4+3 to a 3+4.

If you have radiation or focal therapy as your primary treatment, you never really know what your Gleason score is.

About 50% of the people that are on active surveillance find their Gleason score rises over time. My brother is a perfect example. He had a 3+3 And went on active surveillance for about six years, At that point, he was a 3+4 and a 4+3 And he had SBRT radiation to the prostate. I know of many other people that have had their score go from 3+3 too much higher numbers.

My understanding is that even if low grade the cancer can still grow and breach the prostate. As it grows, subsequent biopsies will find more positive cores and that increases the likeluhoid that a previously missed pattern 4 shows up.
My father may have been a case in point. His cancer was detected when it had already reached the bladder neck and his PSA was 130. But it was still localized without metastases.

@jerbone6634 Thanks, that coincides with what I have researched.

Mine went up from clinical biopsy 2 x 3+3 and 1 x 3+4 (40% Gleason 4) to 4+3 (70% 4) post RALP. In addition added Cribriform and Intraductal. The final pathology found a substantially larger amount of aggressive cancer than the biopsy sampled.

@jim18 Matters to me, otherwise I wouldn't have asked. For me, its not a question of AS, I know that is reality for the rest of my life, whether I have treatment down the road or not. I want to understand the disease, how it progresses, discovery methods, etc. There is a big difference between lower grade progressing to higher grade and it was there all along, it just wasn't identified.....

@jeffmarc thanks Jeff, based on your response the gold standard for identifing PC is severely lacking - although its the best we currently have. Can only hope the future brings about more definitive imaging and lab analysis....jabbing around 12-18 times into the prostate and then only getting 1-2 percent seems highly inefficient.