Why Gleason 6 Prostate Cancer May Not Need Immediate Treatment (2025)

FAQs

Should you treat a Gleason score of 6? ›

Because Gleason 6 is not likely to be aggressive or spread rapidly, active surveillance—monitoring for changes—is often used to watch the cancer over time. This allows a patient to put off treatment, such as surgery or radiation, until it is absolutely necessary. American Society of Clinical Oncology.

Immediate treatment may not be necessary

For some, treatment may never be needed. Instead, doctors sometimes recommend active surveillance.

Of the 241 patients 45 (18.7%) had a significant change in grade from Gleason score 6 or less to Gleason score 7 or greater, increasing to Gleason score 7 in 41 and to Gleason score 8 in 4 (table 1). Of the cases showing progression 24 of 45 (53.3%) did so within 24 months of diagnosis.

Prostate cancer usually spreads very slowly. It generally takes up to 15 years for cancer to spread from the prostate to other parts of the body. But it is deadly if it goes undetected; hence, regular follow-up after the age of 60 is a must.

Gleason score 6 prostate cancer is associated with high survival rates. Many patients with this diagnosis have an excellent prognosis and can expect to live for many years after treatment. The relative 5-year survival rate for localized prostate cancer, which often includes Gleason score 6 cases, is approximately 100%.

The preponderance of evidence suggests that true pathologic Gleason 6 disease, while possessing the ability to grow and extend locally, has an exceedingly low, if any, metastatic potential.

In many cases, prostate cancer is relatively slow-growing, which means that it can take years to become large enough to be detectable, and even longer to metastasize outside the prostate. However, some cases are more aggressive and need more urgent treatment.

“We have studied hundreds of patients who underwent surgery and evaluated the delay between diagnosis and cure,” says Johns Hopkins urologist Patrick Walsh, M.D. “With long follow-up, we found no significant difference in the 10-year cancer control rates of these men.” This is reassuring: “There is no immediate urgency ...

Generally speaking, many patients with prostate cancer undergo surgery to remove tumors or the entire prostate. Surgery may also be performed with radiation therapy to eliminate cancer cells. In other cases, men with early-stage cancer may opt for an “active surveillance” approach.

A Gleason score of ≥7 had an 89.6% sensitivity and 34.8% specificity for bone metastases. Using a Gleason cutoff of ≥8, the sensitivity and specificity for predicting bone metastases were 54.2% and 71.5%, respectively.

Is a Gleason score of 7 a death sentence? ›

Prostate cancer, with a Gleason score of 7, is generally considered to have a positive outlook. Gleason scores of 7 are still considered relatively low-grade and rarely result in death within ten years of diagnosis.

Gleason Score

7 – The cancer is likely to grow and spread at a modest pace; favorable intermediate with few aggressive cancer cells; unfavorable intermediate with more aggressive cells. 8, 9 or 10 – Cancer is likely to grow and spread fast; high grade.

Allium vegetables: This group includes garlic, onions, leeks, and chives, have been shown to help kill prostate cancer cells. Tomatoes: Contain lycopene, which slows prostate cancer growth and metastasis. Your body absorbs more lycopene from cooked tomatoes and those consumed with oils.

About 1 in 44 men will die of prostate cancer. Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 3.3 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.

That's why I generally don't recommend this surgery for a man whose life expectancy is less than 10 years, or for a man who is older than 75, depending on his personal and family health history.

Both treatments work well. With either treatment, the chance of your cancer spreading is low. Both treatments have side effects, such as bladder, bowel, and erection problems. Radiation therapy is more likely to cause bowel problems.

Gleason 6: The cells look like healthy cells, which is called well differentiated. Gleason 7: The cells look somewhat like healthy cells, which is called moderately differentiated. Gleason 8, 9 or 10: The cells look very different from healthy cells, which is called poorly differentiated or undifferentiated.

The lowest possible Gleason score of a cancer found in a prostate biopsy is 6—cancer with the least risk of spreading quickly. The highest score is 10—cancer with the most risk of being aggressive.