Gleason 6

Active Surveillance Patients International: aspatients.org
The Active Surveillor: howardwolinsky...
0:24 What is Gleason 6 prostate cancer?
2:22 If it doesn't metastasize, why is it called cancer?
4:26 Clinical study examines whether Gleason 6 prostate cancer metastasizes
6:56 Spread is something that occurs before the prostate is removed, not after
7:55 Can Gleason 6 prostate cancer transform into a higher grade?
9:31 Is 50% of all prostate cancer Gleason 6?
9:44 How can a patient know for sure that their grade is Gleason 6?
10:42 Are active surveillance patients less likely to die of prostate cancer?
11:15 How should a patient handle being advised to treat Gleason 6?
13:19 Can active surveillance continue indefinitely?
14:15 At what level is a PSA considered potentially concerning?
15:06 How often does a second pathology result in a new Gleason grade?
16:17 Is there any context in which a Gleason 6 patient should seek treatment?
17:49 Alex's conclusions
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[@TheRedTrucks]

Thank You soooo much for your thorough information! It’s very empowering!

[@colemant6845]

BTW... Another amazingly informative video with information that my Urologist(s) have never shared with me. THANK YOU!

[@afshinPROF]

very grateful for your videos. I had a Gleason 6 diagnosis in 2017 (at 47 years old). I chose RP, which I agree may have been over-treatment. Now at 55 years old I'm having BCR (PSA .21) I had a PSMA scan (a month ago) which showed a small spot on a rib. Pelvic zone was clear. My radiologist thought the spot on the rib might be metastasis, but with the knowledge I've gained from your videos I was able to argue that "Gleason 6 doesn't spread." My team of doctors have now concluded that the PSMA spot was likely a "false positive," probably showing a spot from an old injury. I'll do an other PSMA in 6-12 months to check for any changes. A video on PSMA "false positives" might be a good idea. Thanks for all of your videos, which truly empower your viewers.

[@Ozymandias-r2v]

If the radiologist assumed the spot on the rib was an old fracture and it ended up being a metastasis (prostate or other) you would sue him.

[@allanc9472]

Sometimes, getting a second opinion can really make a difference on what path you take and how it might affect the quality life.

[@davidmarshall2486]

Thank you I’m a Gleason six getting a MRI done tomorrow needed to see this video and getting another biopsy done under Active surveillance

[@monetizepresentknowledge5621]

I had an MRI targeted biopsy second time around instead of a regular random biopsy. Much more accurate and by the grace of God, results came back benign.

[@Midnitexowboy]

How r u

[@monetizepresentknowledge5621]

@@Midnitexowboy doing well, thanks.

[@davidmarshall2486]

Fine thank you 😊

[@allanc9472]

@@monetizepresentknowledge5621 Do you have lesions shown on the MRi? That is why MRI is useful, if no lesion found then I wonder if one still need a biopsy at all?

[@timothywest3575]

God bless you both for sharing this excellent info.

[@TERRY-cb2ku]

I'm praying for a Gleason score of 3+3 or something benign when I have my biopsy soon.

[@jamesspadaro1996]

Me too

[@allanc9472]

Did you do the prostate MRI first?

[@joeysocks5718]

Thank you for the great information. I’m Gleason 6 for 2 years, and PSA remains steady. I’m in no rush to have surgery or get radiated.

[@allanc9472]

What is your PSA and prostate size?

[@AIfans999]

GOD bless you both and the PCRI! Appreciate the honest opinion and that you have the best interest of the patients. All the questions asked are so relevant and answered and addressed the concern that I have. Very very much appreciated! Thank you Thank you Thank you!

[@ektalon1]

Agreed. BIG time.

[@terrymulloy1977]

I've had prostate cancer with a Gleason score of 6. Thank God I found a doctor who understood active surveillance. This was great information. I appreciate it.

[@24hourgmtchannel64]

3:15 is the key takeaway for Gleasone 6 dignosis for me. I was diagnosed in 2021 with low grade Gleason 6 and this very reference, alos stated by other urologist in the field was enough for me not to choose to wait. As I've also heard many times, one doesn't really know the full extent of the disease until the prostate is out, dissected in pathology, and given a final grade. Active survalince always went against what I learned while working IT support in a large hospital for over twenty years arond doctors and nurses and that is, the key to surviving cancer is early detection and early treatment which active survalince contradicts but that's just my view.

[@Giovan_Nino]

Very well put together..been watching this channel for a number of years now. However I’ve noticed you are getting so proficient and know what you are talking about so well, that you have managed to speed up your speech to a level that is now becoming difficult to follow..Just an observation with many thanks for your great work…

[@RLTtizME]

I am 76 and recently diagnosed (2/24) with prostate cancer with a Gleason score of 7 / 3+4. I have had my prostate digitally checked at every yearly physical for years. Diagnosed with an MRI, Fusion Ultra Sound used for the biopsy and a follow up PSA of 4.15 this month. My PSA has fluctuated between the 4's and 5's for years. I am on active surveillance for now. I don't think I would ever agree to a Prostatectomy (side effects and quality of life) unless circumstances were dire... but would explore other treatment options as discussed with my Doctor.

[@leonardola9161]

That's good know your options.... I have 3+4 7 I'm doing 28 radiation treatments .

[@markusrose9667]

Wish you had addressed whether it makes any sense to get one of those genomic tests after a G6 dx.

[@cheese9879]

I just had a HeLOP and a andenocarcimoma, group 1, 3+3=6 was found. My urologist recommended monitoring.

[@trustinsaam5415]

Very informative and reassuring!

[@jdotoz]

It sounds like the important thing is to understand that active surveillance *is* treatment.

[@insanecnc]

I am 61 and my Dr. recommended I get an MRI with contrast of my prostate because my PSA was at 4.4. The MRI showed a couple lesions so my Dr. recommended a biopsy. Out of the 12 or 13 core sample biopsies taken 9 of those samples came back all Gleason 6, 3+3. I am considering just doing active surveillance for now and do a PSA check every 6 months. But what makes me nervous is that 9 out of the 13 samples were considered cancerous 3+3. My Dr. went over a list of options but suggested removing the prostate may be the best option. As far as I know there is nobody in my family history with prostate cancer. My dad passed away at 90 years old but not from cancer and I do not believe he ever had a PSA test in his life.

[@chitterlingsrtasty]

I’m in a similar situation. 10 out of 13 samples initially 3+3. 2nd opinion resulted in the sample from the one lesion being 3+4 (5% of it was 4). First urologist recommended prostate removal (that was with it only being Gleason 6) 2nd urologist recommended whole prostate treatment as well. I’m trying to determine if I do focal therapy for 3+4=7 and AS for the Gleason 6. Waiting on onkotype test to determine what to do on the Gleason 7. I have an uncle who recently passed from prostate cancer in his mid 70’s (im 51). I’m not sure of the specifics of his cancer.

[@williewonka6694]

That's almost my exact situation, age 64, PSA 5.3, Gleason 6 on 9 of 12. Grandfather died of prostate cancer.

[@allanc9472]

@@chitterlingsrtasty Look like Gleason 6 from what I read and this video suggest AS. As far as the 3+4 and only 5% was 4 seems reasonably able to still do AS but again is just my opinion. Surprise the 1st Urologist jumps to as far as even surgery to remove the prostate.

[@tshelley4232]

I was diagnosed with 3+3. Urologist strongly recommended surgery removal of prostate. He got agitated as I deemed it not necessary. That was 5 years ago.

[@allanc9472]

Sad, they are not for your concerns but for their own pocket.

[@orangeguy3314]

@@tshelley4232 Good for you!. Not to let him remove your prostate. I'm a 3+4 and my doctor. Thinks I'm good at just staying on active surveillance for the next ten years.

[@blahblahblah9376]

Holy hell!

[@ashokagarwal1401]

Yes

[@efrainbonilla9532]

Once diagnosed with Gleason 6 is it necessary to have a new biopsy annually?

[@nvan78]

Initially considered Gleason 6 (3+3) in 2017 and been on Active Surveillance since. TURP surgery a year ago to deal with BPH issues as well, but my PSA has not diminished at all (last reading was 22). My sense is something has been missed here. Have a discussion with a radiation oncologist in about a week to see if they can shed any light on this. PSMA - Pet scan in the last two months which showed plenty of activity in the prostate and a suspicious thyroid nodule but thats about it.

[@allanc9472]

My PSA jump from 4.8 to 7.8 in a year. Got a prostate 3TMRI, shows no suspicious lesions but suspect chronic prostatitis. Still waiting to see the Urologist for his interpretation and see if a biopsy is still warranted since the PSA is still high but then it could be elevated due to prostatitis. Should the prostatitis be treated first and maybe it may go back down to my usual range for the last few years. I know he wanted to do a biopsy when he send me to do the MRI. What do you think?

[@postmurrmerkulov9295]

After the biopsy, my result was 3+3. After the operation pT3a and also 3+3. And also R1

[@waelfadlallah8939]

You shouldn't have done the surgery

[@VictorDeLaCruz536]

In six month, my PSA drop from 213 to 163

[@SeekingWisdom17]

PSA is very high for a GS 3+3. Do you have a high volume prostate?

[@frankv5217]

i was recently diagnosed with Gleason 6 a few months ago. Urologist immediately start talking about a radical prostatectomy if he see any change in the future. However, my question is how quickly does a Gleason 6 move/change to a Gleason 7 or higher? There is all this great discussion about Gleason 6 but of course the next question is do I live at Gleason 6 forever or does it eventually progress? If so what does the data tell us?

[@bigr4655]

I had a 13 point biopsy (12 random plus 1 targeted) following a standard MRI that initially did not find anything but later did find a "speck" with another person looking at it. Nine of the 13 had nothing, the remainder had 3 + 3. My urologist says the volume was high at anywhere between 40 to 70% of the length of the core samples themselves. . The volume of a cancer cells never seem to be a topic of discussion, could you one day make a video discussing that aspect? Volume does not seem to be a topic of anyone's videos, and though I don't remember at the moment my urologist has stated that that my " high-volume" is a problem for me.

[@bigr4655]

Btw, I was 59 when biopsy was taken. I'm 60 now in case you have any comments. Thanks !

[@monetizepresentknowledge5621]

I was 56 when I had a random biopsy. That was in 2018. The problem is, it's a "random" procedure. Last year I had a PSMA-PET scan then an MRI targeted biopsy- that's where you're in the MRI during the procedure. These procedures are much more accurate. Don't depend on random medical treatment.

[@monetizepresentknowledge5621]

Sorry, I meant 3+3, not 6+6.

[@Ozymandias-r2v]

Is Gleason 6 prostate cancer, by itself, a risk factor for developing Gleason 7 or higher cancer or is the risk the same as a man without prostate cancer, all else being equal?

[@williewonka6694]

good question

[@JamesWyckoff-g6w]

God bless you for this info...what are yoyr thoughts on creatine snd collogen suplements with a gkeason 6 diagnosis?

[@timstephens2866]

What is the ratio formula, mentioned in the video, between my PSA number and prostate size?

[@TiHerr74]

In my case, my prostate measured 74 mL and my last PSA score was 5.7 ng/mL. So my PSA density is .077 ng/ml/cc. The lower the number, the better with .15 considered an actionable level.

[@richardzelinka9411]

Divide the psa by the prostate size. The conventional wisdom is that any result below .15 is within the range of "normal".

[@cynthiabrenton9615]

Over the last few years my PSA has been slowly increasing. I’m 65. Last fall my PSA reached 4.0 and because of a family history of PC my urologist recommended doing an MRI & followup random 12 core biopsy if the MRI showed anything. 3 of the 12 cores came back with Gleason 6. I dropped approximately 40 lbs this spring on a low carb, no sugar, no alcohol diet. Recent PSA came back at 3.7. Can you tell me if the drop in PSA is most likely related to the weight loss?

[@MyFrank71]

thats a great question

[@iamric23]

Why were so many men who were diagnosed with 3 plus 3 operated on to remove their prostate? Is this something that I should have done to me, I also have a 3 plus 3. I forgot to thank the two of you, without these videos I would be lost.

[@monetizepresentknowledge5621]

Because it is a huge business and urologists are surgeons. Don't let them scare you into surgery when 6+6 isn't even considered cancer.

[@allanc9472]

@@monetizepresentknowledge5621 You mean 3+3?

[@scottgraves4754]

Up until 2007 i believe they were still treating gleason 1s and 2s and for sure 3s. At that time they were still calling gleason 1 and 2s cancer. Now they don't even note it on pathology report. So, many unfortunate souls went through treatment for gleason 1 and 2 before urologists decided that gleason 1 and 2 is harmless. Now the conventional wisdom is that pure gleason 3 is also harmless and won't spread. The problem is that they sample such a small area of the prostate and may miss a more aggressive cancer and MPMRIs aren't infallible.

[@iamric23]

@@scottgraves4754 I'd like to see a guideline as to how to perfectly treat each of the Gleason scores, instead of these places that are selling there way to do it. It just seems irresponsible to just hack at it.

[@williewonka6694]

So, here I am, age 64 with PSA 5.3, MRI identified likely lesion, which biopsy found half the gland, 9 of 12 cores at Gleason 6. Grandfather died of Prostate cancer, losing about 10 years of life. I remember he was told that it was slow growth and he would die of something else. Well, he didnt. Not sure if active surveillance is right for me.

[@leonardola9161]

I thought Gleason 6 doesn't metastasis so why not just watch it??

[@williewonka6694]

@@leonardola9161 Yeah, biopsies don't sample every part of the tumor and new cancers may continue to develop, over time.

[@colemant6845]

This is a very confusing PCRI video for me... 11 years ago I was diagnosed with 3+3 PC. Had High Dose Radiation (HDR) and PSA declined to .2 for the last 11 years. Now my PSA has climbed to 6. The PSMA scan showed a single lymph node spread. 2 subsequent biopsies of both the Lymph node and and my Prostate were BOTH benign! Now... I have a Guided Fusion Prostate Biopsy scheduled (June 6th)... Is this the "best" next step??

[@monetizepresentknowledge5621]

I had 3+3 and PSA 17 in 2018. I refused surgery. Last year I had PSMA PET scan and MRI targeted biopsy which was benign. My PSA was last at 15 and I am on active surveillance.

[@allanc9472]

@@monetizepresentknowledge5621 Could the high PSA due to BPH or prostate inflammation like Prostatitis?

[@monetizepresentknowledge5621]

@@allanc9472 that's what I'm hoping the explanation is.

[@scottgraves4754]

@@monetizepresentknowledge5621 I'm in a similar situation. PSA started rising in 2019 from 5.5 to 19.14 yesterday. I've had 2 3TMPMRIs showing pirads 5 lesion. I've had 3 biopsies, one MRI targeted, showing gleason 3+3 nine cores out of 12. MPMRI also shows evidence of BPH and prostatitis. Doc says BPH and prostatitis won't raise PSA to almost 20. So, next step is a PSMA Pet Scan to see what it shows. I'm assuming I'm not pure gleason 3+3, or PSA wouldn't be so high. No history of prostate cancer in my family, but I can only go back one generation. I also had a job in 2019 where I was exposed to high dose of RF radiation on the job, which I stupidly didn't report. I was pretty sure I would have been fired had I reported the exposure, as I was a contractor. Days after exposure, I started getting strange warm sensations in my groin/prostate area. So, I'm still thinking this could all be from that high dose RF radiation exposure at work.

[@scottgraves4754]

Urologist did recommend surgery after first biopsy showed gleason 3+3. Wanting to avoid the more than likely side effects, I opted for AS. I'm so happy to be able to watch these informative videos. After watching Dr. Scholz, I will probably opt of some kind of radiation therapy, hopefully focal brachytherapy, if I qualify for it, since my lesion is really close to the margin.

[@johnstewart917]

In 2006 had prostectomy, pathology report gleason 6 3+3. No detectable PSA until 2016 then a slow rise. PSA now 0.2 and has been holding steady for 6 months. I have had PSMA PET and MRI (T3), nothing shows in the scans. My question, can this be a different prostate cancer? When the prostate was removed the tumor had not penetrated the capsule.

[@StarExplorer123]

What if you have Gleason 3+3 but the tumor breaches the prostate capsule? Then what?

[@HowieGreen-v2q]

Good question

[@fredwelf8650]

The issue with 3+3 as with any Gleason score is ‘why does metastasis occur?’ G6 is an ambiguous diagnosis because the underlying belief that it is not cancer belies the purpose of AS and the suspicion that the biopsy missed the cancerous tumor cells in the prostate. Furthermore, there is a skepticism about whether a g6 can become a g7, or a g7 into a g8. If cancer is a dedifferentiating process, why would it stop at 6 or 7 or 8, etc. That is, does the cancer stop with g6, or g7, etc. It’s doubtful. This implicates the “leap’ from a g score to ‘advanced’ or metastasis. In parallel, there seems to be a “leap” from cancer inside the prostate to cancer outside the prostate, to bone or lymph or elsewhere. The leaps indicate that the cause of metastasis is not well understood. Apparently, as cancer cells accumulate in the prostate, the likelihood of a breakout increases. But, might not the biopsy procedure cause cancer cells to escape the prostate. What causes metastasis; how does it occur? What is a metastatic event? Lastly, it is incomplete to claim a fact on the basis of data, as when very few g6’s out of 12,000 eventually developed PC. It is necessary to offer an explanation, reasoning. In other words, why does the probability of cancer increase for any initial condition?

[@graemefraser1948]

“might not biopsy procedure cause the cancer cells escape the prostate?” This is a very good question. My limited research says that it’s possible, but is not considered as a relevant risk by the medical fraternity. Although there certainly seems to be support for moving away from biopsy. My semen was bloody for a month following a random/pattern biopsy….it certainly traumatized my prostate.

[@Ozymandias-r2v]

Certainly the complete picture of Gleason 6 prostate cancer is not understood but what is becoming clear is that not all Gleason 6 is the same. Its just that they look the same under a microscope to a pathologist. Genetically there appears to be many different entities that are grouped together as "Gleason 6". It seems a minority of those can dedifferentiate but that many do not. The ones that do not dedifferentiate in fact would not be cancer at all if you could distinguish them from the others. The situation is somewhat analogous to DCIS with breast cancer. Some DCIS goes on to IDC and some never does. Granted alot more DCIS progresses than Gleason 6. Treatment decisions are all about the risk/benefit to each of us. The more information that you can obtain about your personal Gleason 6 the better. I am really looking forward to advancements on the genetic front in the next few years. Hopefully the scientific advancements outpace my PSA advancement.

[@Ozymandias-r2v]

@@graemefraser1948 From what I have seen biopsy seeding is a real thing but typically happens with very aggressive kinds of cancers such as sarcomas. Most cancers have to go through various suites of mutations before they can survive in a different tissue "soil".

[@josephmaher1350]

Thank you again for such expert, intelligent discourse. These videos are gems, presented beautifully.

[@T.Z.M4N]

I had a prostatectomy back in 015 and everything good with o PSA. It would rise and fall and after that for a year and a half now it has jump tp 0.520 My doc had me do a PET Scan which shows nothing.He wants me to do radiation for he still thinks there is cancer now.How do I react to this?

[@RedAramis4]

I'm going to show this to my urologist. I have 3+3=6 Gleason in 4/12 cores and he's wanting to remove the prostate. If 3+3 doesn't metastasize, I question why the need for a Radical Prostatectomy?

[@leonardola9161]

Why have it removed it won't metastasise ?

[@allanc9472]

So what did you decide? And what the urologist says of your decision?

[@scottgraves4754]

Many urologists are not up on the latest when it comes to prostate cancer. And many patients, when they hear the word "cancer" just want it removed, which is an understandable response. The uros have a motto, "when in doubt, take it out." Get to a prostate cancer center of excellence and get a second, third, and even fourth opinion. My first uro, who was a surgeon advised me to remove my prostate over a Gleason 6+6. I opted to get other opinions.

[@leonardola9161]

@@scottgraves4754 good for you dont panic. Im 64 i had 3+4 7 Hormone shot 6 months lupron And 28 radiation treatment to keep my prostate and im ok

[@VictorDeLaCruz536]

I was diagnosed last year with Gleason 6 i’ve been on active surveillance for six months. I want to have the robotics surgery. I do not want to have this disease in me What you recommend.

[@dondgc2298]

Look for a video called “why Gleason 6 is not cancer.” And relax and enjoy your life. And keep your prostate.

[@leonardola9161]

I'm 63 Gleason 3+4 7 they did a MRI 1st then if the find something they do a psma pet scan then a biopsy.

[@allanc9472]

@@leonardola9161 What diagnose your Gleason 3+4? MRI?

[@leonardola9161]

@@allanc9472 targeted biopsy And then pet scan to confirm

[@edotero6331]

I am 3 plus 3 2 of 14 cores. Been on AS for 4 years. I get a MRI check every year and I get PSA every 6 months. I have a 89ml prostate, its big so in 4 years its has been around 4 one 5 and last month 7 because I had prostitis. I also fired 2 urologists because not satisfied with their treatment recommendations or they were not good listeners. I have a 3rd one now and these videos have educated me, I have more knowleadge and can discuss with my Dr options. I am 64. So we all going to die one day but we have to follow the facts. 3 plus 3 doesnt spread. erection problems or wearing a depends when you can avoid. My friend is like you. I just want to get the cancer out and now he tells me I should have not done it. My quality of life is the shits. its your body but look at the research and the facts. good luck

[@orangeguy3314]

Don't get the mri. I got a mri and didn't find anything. Also in the report. It said basically it wasn't good at finding for those having 3+3 or 3+4. Next time I'm going for a mri pet scan.

[@allanc9472]

My prostate 3TMRI 1st line says, No lesions with characteristics specific for Gleason 7+ prostate cancer were identified. I interpret it as no lesions for 3+4, 4+3, 8, 9, 10 found. Further details also says no suspicious lesions in Peripheral and Transition Zone. Hope this is a good MRI result?

[@orangeguy3314]

@@allanc9472 yes and no.., the paperwork that I got with the score said : results of the mri were not good at finding with those with 3+4 and 4+4. I talk to my doctor about that note add in the test results paper. He then said to yes. It wasn't the best test for find cancer within the 'whole' prostate, but he added it was good at finding it in the transition zone. Which he thought was were any of it would be left over. After I got my hoLEP procedure done. Next year I'm getting the mri-pet scan and the doctor agreed to it for me. It can find cancer at the size of a bb. I think your ok. As my doctor and all the other professionals agree. You and I have little to worry about for the next ten years. Keep on doing your two psa blood test and mri every year. One of the reasons I wanted the hoLEP procedure is because it removes a lot the material inside the prostate. As well as getting rid of my bph problem. What is your psa score?. Mine is a 7.9 and staying steady at that number for over two years now.

[@Blanco83]

If Gleason 6 does not spread why do active surveillance? Seems like you waiting for the train to leave the station, then you would be dealing with a bigger problem.

[@Ozymandias-r2v]

Because the train may never leave the station and the treatment could be worse than the cure.

[@leonardola9161]

He's doing surveillance to watch for other possible cancer

[@Ozymandias-r2v]

@@leonardola9161 There is a good possibility that some Gleason 6 will progress and some will not but the genetic analysis is not advanced enough yet to discriminate between the two so for now everyone will Gleason 6 needs to do surveillance. If you catch a Gleason 7 or 8 before it metastasizes, you may get a cure with intervention. If it never progresses you avoid the complications of intervention which can significantly decrease quality of life.

[@Ozymandias-r2v]

My grandfather was diagnosed with Gleason 6 at age 55. He watched it until he was 86 when it suddenly progressed (or he developed de novo advanced disease) and died of it at age 87. That was in 2007.

[@allanc9472]

@@Ozymandias-r2v Agree with that assessment :).

[@jamesdante2335]

Can 3+3 ever lead to biochemical reoccurrence?

[@dondgc2298]

You can’t have recurrence if you have not removed anything.

[@fredwelf8650]

@@dondgc2298. You can have recurrence if you became undetectable or negligible with ADT and the cancer returned increasing the PSA. imo

[@dondgc2298]

@@fredwelf8650 valid point. I was really trying to get at “what are you doing to this Gleason 6 that it has disappeared to the point there can be a recurrence,” given that Gleason 6 is generally not treated. But of course you are correct.

[@iguanaamphibioustruck7352]

At some point you need to ask. Are you aiding with the solution or adding to the problem. I probably have Gleason 3 but a "Rose under any other name, smells the same". You doctors have your own language. Putting on KZbin, open for question, does not help me at all.