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Gleason 6 (3+3) treatments

Posted by joe1 @joe1, May 21 3:39pm

Hi,
I had a biopsy and it came back with Gleason 6 (3+3). The urologist first told me it was extremely important that I have a biopsy done every 12 - 18 months to monitor this. 3 years later with no followups and now he's telling me we will just do MRI's instead (I also have ulcerative colitis so biopsy is extra painful). He also told me my cancer is nothing and don't worry about it. Problem is, he's told me a lot of things and then told me the exact opposite, so I'm not sure if I trust him.

Question for others with Gleason 6 ....... what type of treatment/monitoring are you being treated with?

Thanks

Joe

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tuckerp | @tuckerp | May 21 8:15pm

I dont know but doesnt seem like all the answers. Mine was gleason 6 3+3. But you need more information than that. PSA tests? I think a biopsy but maybe thats old school. Just saying 3+3 is not considered bad.

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robertmizek | @robertmizek | May 21 8:58pm

Hi, I’m a prostate cancer patient not an MD so please understand that my comments reflect my personal experience and are not medical advice.

May I respectfully ask what your last PSA number was?
Also may I ask whether you are having a “standard” PSA test or whether you are having a PSA -ISO test (PSA with reflex)?
Did you have an MRI guided FUSION biopsy or random?

It’s been my understanding that true Gleason 6 cancer never becomes a problem. The question then becomes whether your biopsy was thorough enough not to miss significant disease that would raise the score to a 7 or higher. My single biopsy showed a Gleason 6 and missed significant cancer that would have resulted in a score of at least 7. When the biopsy results didn’t match my MRI scan I should’ve insisted on a follow up biopsy before agreeing to treatment that didn’t eliminate the cancer the first time around.

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2 replies
jasonfarmer | @jasonfarmer | May 22 9:53am

Second option is what I would do. I was also 3+3 =6 with biopsy and mri I chose prostatectomy (surgery) . Father had prostate cancer at 52 , I was 58 @1 year ago. Turns out good decision, I was actually 3+4=7 and high risk 93% according to dicipher test. Presently cancer free undetectable psa . I hope all goes well for you.

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joe1 | @joe1 | May 22 11:57am

Thanks for that info. I'm in Canada and they will not allow you to get second opinions. Can I ask..... are you OK now after the prostatectomy? No bad side effects (I was told I would be incontinent for a year and potentially have sexual problems)? Was it robotic controlled? Thanks again, Joe.

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2 replies
joe1 | @joe1 | May 22 12:06pm
In reply to @robertmizek "Hi, I’m a prostate cancer patient not an MD so please understand that my comments reflect..." + (show)
@robertmizek

Hi, I’m a prostate cancer patient not an MD so please understand that my comments reflect my personal experience and are not medical advice.

May I respectfully ask what your last PSA number was?
Also may I ask whether you are having a “standard” PSA test or whether you are having a PSA -ISO test (PSA with reflex)?
Did you have an MRI guided FUSION biopsy or random?

It’s been my understanding that true Gleason 6 cancer never becomes a problem. The question then becomes whether your biopsy was thorough enough not to miss significant disease that would raise the score to a 7 or higher. My single biopsy showed a Gleason 6 and missed significant cancer that would have resulted in a score of at least 7. When the biopsy results didn’t match my MRI scan I should’ve insisted on a follow up biopsy before agreeing to treatment that didn’t eliminate the cancer the first time around.

Jump to this post

Hi and thanks for the reply. My PSA is a 4.3, but I'm in Canada and I think they measure it differently. However, I was told it is within the normal range. I think it was just standard PSA as the ISO does not ring a bell. My biopsy was not MRI guided (just ultrasound), was 12 cores and only 1 core had the cancer and they told me it was a small amount. However, the biopsy also said my prostate was only 37cc in size, and the followup MRI said it was 62 cc, and the doctor told me the MRI is far more accurate, so that makes me wonder if they missed something in the biopsy as you say. The MRI didn't detect any tumors. Can I ask what treatment you had and how effective it was? Thanks Joe

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2 replies
southgeorgia | @southgeorgia | May 22 1:34pm

I am Gleason 3+3, latest PSA was 4. I went to Mayo and had an MRI - no signs of cancer spreading. I’m on active surveillance, PSA every 6 months and, at first they said annual biopsy, but I think they’ve decided an annual MRI.

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wsx | @wsx | May 22 5:37pm

My G 3+3 in one of 6 biopsies and less than 5% of total cells. I had been in AS for one year but the PSA gradually increased to 9.8. I believe that for localized PC , RT has the same good result of cancer free compared to surgery in short or long term. I finally went 28 sections of IMRT. Six weeks after IMRT , PSA 0.02.

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robertmizek | @robertmizek | May 22 8:39pm
In reply to @joe1 "Hi and thanks for the reply. My PSA is a 4.3, but I'm in Canada and..." + (show)
@joe1

Hi and thanks for the reply. My PSA is a 4.3, but I'm in Canada and I think they measure it differently. However, I was told it is within the normal range. I think it was just standard PSA as the ISO does not ring a bell. My biopsy was not MRI guided (just ultrasound), was 12 cores and only 1 core had the cancer and they told me it was a small amount. However, the biopsy also said my prostate was only 37cc in size, and the followup MRI said it was 62 cc, and the doctor told me the MRI is far more accurate, so that makes me wonder if they missed something in the biopsy as you say. The MRI didn't detect any tumors. Can I ask what treatment you had and how effective it was? Thanks Joe

Jump to this post

Hi Joe. Sorry for the late reply. Unusually busy day.

As far as I can tell, PSA readings in Canada and the United States are interchangeable. You can find more information here: https://www.inspire.com/groups/zero-prostate-cancer/discussion/comparing-canadian-psa-levels-to-american-psa-levels/?p=1&sort_order=DESC&reply_structure=unthreaded

A ISO-PSA test is an advanced test that helps determine if a higher PSA number is related to prostate cancer. It is available in Canada. More info here: https://pcstoronto.ca/2017/07/02/new-isopsa-assay-detects-prostate-cancer-precisely-current-tests/

The fact that your MRI didn’t notice anything is interesting. Do you know if it was a 3 Tesla MRI with and without contrast. If the MRI was done on older equipment (1.5 T) it might not have had the resolution to spot significant cancer.
More info here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9373864/

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robertmizek | @robertmizek | May 22 8:48pm
In reply to @joe1 "Hi and thanks for the reply. My PSA is a 4.3, but I'm in Canada and..." + (show)
@joe1

Hi and thanks for the reply. My PSA is a 4.3, but I'm in Canada and I think they measure it differently. However, I was told it is within the normal range. I think it was just standard PSA as the ISO does not ring a bell. My biopsy was not MRI guided (just ultrasound), was 12 cores and only 1 core had the cancer and they told me it was a small amount. However, the biopsy also said my prostate was only 37cc in size, and the followup MRI said it was 62 cc, and the doctor told me the MRI is far more accurate, so that makes me wonder if they missed something in the biopsy as you say. The MRI didn't detect any tumors. Can I ask what treatment you had and how effective it was? Thanks Joe

Jump to this post

When I was first diagnosed with Gleason 6 low risk cancer in 2020 I opted for focal brachytherapy. Unfortunately, I was under diagnosed and the cancer came back with a vengeance in 2023. I’m now on a journey with Stage 3 locally metastatic prostate cancer. That’s why I’m on this forum; to help inform other men so they have the best chance to get the best diagnosis and treatment possible the first time around.

Hope this helps you!

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