Why Gleason 6 Prostate Cancer May Not Need Immediate Treatment (2024)

Gleason score 6 is the lowest grade of prostate cancer. This rating means that the prostate cancer is considered to be low- or very low-risk disease, or group 1. Most of these tumors are found during routine prostate cancer screenings.

Gleason 6 prostate tumors grow slowly and may never cause a problem—or even need treatment. Still, they should be monitored.

Why Gleason 6 Prostate Cancer May Not Need Immediate Treatment (1)

This article outlines what Gleason 6 prostate cancer means, why monitoring is important, when treatment may be considered, and questions you can ask your urologist if you’ve been diagnosed.

The Gleason Grading System

Screening for prostate cancer involves the prostate-specific antigen (PSA) test and a digital rectal exam. If results are suspect, your healthcare provider may recommend a prostate biopsy—the only way to confirm the diagnosis.

During a prostate biopsy, a urologist uses a small needle to remove tissue samples (usually 12) from different parts of the prostate. These samples—also called “cores”—are then sent to a pathologist so they can review each one under a microscope.

The pathologist uses a pattern scale, developed by Donald Gleason, MD, PhD in 1966, to give each sample a grade from 1 to 5. Grade 1 cells are “well-differentiated” and look like normal tissue. Grade 5 cells, on the other hand, are "poorly differentiated" or even unrecognizable from normal tissue.

Your Gleason score is the sum of the two numbers that represent the most common types of tissue found in your biopsy. The first number in the equation is the most common grade present, the second number is the second most common grade. For example, if seven of your cores are grade 5 and five are grade 4, your Gleason score would be 5+4, or a Gleason 9.

What stage of cancer is Gleason 6?

Gleason score helps determine which stage of cancer you have, but it has a different meaning. Gleason score describes how abnormal the tumor cells are and how likely they are to spread. Stage describes where the cancer is located and how far it has spread. It is possible to have a Gleason score of 6 with either stage I or stage IIA, which are found only in the prostate.

Today, pathologists typically only flag tissue samples that are grade 3 or higher, making 6 the lowest Gleason score.

In 2014, a revised grading system for prostate cancer—called Grade Groups—was established. This system builds on the Gleason scoring system and breaks prostate cancer into five groups based on risk. This can help make it easier to understand the Gleason score scale.

Prostate Cancer Grade Groups
Gleason ScoreGrade GroupRisk Group
Less than or equal to 61Low/very low
7 (3+4)2Favorable
7 (4+3)3Unfavorable
84High
9-105Very high

Your Gleason score tells your care team quite a bit, including:

  • Whether cancer is present in your prostate
  • How quickly it is growing
  • How likely it may be to spread to other parts of your body

This helps you work with your urologist to make informed decisions about next steps.

What Does Gleason 6 Mean?

A Gleason score of 6 is different from other prostate cancer diagnoses because it means all the biopsy samples are grade 3 (3+3=6). Though the samples don’t look like normal tissue, no grade 4 or 5 samples were found.

A Gleason score of 6 means that all of the tissue samples in your biopsy were grade 3. This means that the cells are not normal, but aren’t necessarily aggressive or causing a concern. Gleason 6 prostate tumors are:

  • Small
  • Confined to the prostate
  • Not causing any symptoms

Prostate cancers with a Gleason score of 6 are not usually considered serious. There are changes at the cellular level, but the prostate cancer is likely slow-growing and has a low-risk of metastasizing, or spreading to other areas of the body.

This knowledge allows your healthcare provider to monitor you and see how your tumor changes over time.

Cancer Controversy

Some experts say Gleason 6 prostate tumors should not be called "cancer" because of their low-risk nature and the fact that the term may cause some patients to be overtreated.

This, however, runs counter to the stances of major medical organizations.

Terminology aside, the bottom line is this: Though not all prostate cancers require active treatment right away, your healthcare provider can’t monitor a tumor if they don’t know it’s there.

How Gleason 6 Prostate Cancer is Treated

In the past, men with prostate cancer—regardless of whether it was aggressive or not—were almost always treated right away with a targeted therapy like surgery or radiation. However, in recent years, experts have revisited this “one-size-fits-all” approach to prostate cancer.

Experts now understand that low-risk prostate cancer—like Gleason 6 tumors–may not need treatment right away. In fact, major medical associations, including the American Urological Association and the Society for Urologic Oncology, now recommend the use of active surveillance for low-risk prostate cancer.

Watch and Wait

Though it is sometimes called “watchful waiting,” active surveillance doesn’t mean that you do nothing but sit and wait. Instead, it means your healthcare provider will monitor your tumor over time with periodic PSA tests, digital rectal exams, and biopsies to see if it changes.

Watching the tumor closely will allow your healthcare provider to step in when necessary so they can treat your tumor before it has a chance to spread to other parts of your body. Your urologist will work with you to determine how often each of these tests should be done to ensure that your tumor is being appropriately monitored.

Studies have shown men with low-risk disease on active surveillance continue to show good results even after a decade or more.

Postponing therapy until it’s necessary allows you to maintain your normal lifestyle and avoid potential side effects of prostate cancer treatment, such as incontinence or erectile dysfunction.

Monitoring Your Gleason Score

If your Gleason score changes while you’re on active surveillance, it’s time for a discussion with your urologist to better understand the situation.

You may find it helpful to ask these questions:

  • In what way did my Gleason score increase? Remember that the numbers that comprise your Gleason score represent the two most common grades of tissue in your biopsy. Finding out which number increased is important to understanding how your tumor has changed. A change in your first number (for instance, a new Gleason score of 4+3) means that most of your tissue samples are now grade 4 (higher risk). A new Gleason score of 3+4 means that grade 3 (low risk) is still the most prominent type of tissue in your biopsy.
  • How does this impact my risk level? Your risk level is based on the distribution of grade 3 and grade 4 samples. A Gleason 7 (3+4) has a more favorable risk level than a Gleason 7 (4+3).
  • Is it time to consider active treatment? It can be unsettling to find out that your prostate cancer has changed or may be getting worse. However, even if your urologist recommends staying on active surveillance, it may bring you peace of mind to better understand at what point you’ll need to consider other options.

Summary

Gleason 6 prostate cancer is one of the most commonly diagnosed types of prostate tumor. It is the most low-risk type of the disease.

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.

10 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. American Society of Clinical Oncology. Prostate cancer: Stages and grades.

  2. Gearman DJ, Morlacco A, Cheville JC, Rangel LJ, Karnes RJ. Comparison of pathological and oncologic outcomes of favorable risk Gleason score 3 + 4 and low risk Gleason score 6 prostate cancer: Considerations for active surveillance. J Urol. 2018;199(5):1188-1195. doi:10.1016/j.juro.2017.11.116

  3. Prostate Cancer Foundation. Gleason score and grade group.

  4. American Society of Clinical Oncology. Cancer.net. Prostate cancer: Stages and grades.

  5. Egevad L, Delahunt B, Srigley JR, Samaratunga H. International Society of Urological Pathology (ISUP) grading of prostate cancer – An ISUP consensus on contemporary grading. APMIS. 2016;124(6):433-435. doi:10.1111/apm.12533

  6. Epstein JI. Is Grade Group 1 (Gleason score 3 + 3 = 6) adenocarcinoma of the prostate really cancer? Curr Opin Urol. 2022;32(1):91-95. doi:10.1097/MOU.0000000000000945

  7. American Cancer Society. Prostate cancer stages and other ways to assess risk.

  8. Choyke PL, Loeb S. Active surveillance of prostate cancer. Oncology (Williston Park); 31(1):67-70.

  9. American Urological Association. Clinically localized prostate cancer: AUA/ASTRO/SUO Guideline.

  10. Tosoian JJ, Mamawala M, Epstein JI, et al. Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer. JCO. 2015;33(30):3379-3385. doi:10.1200/JCO.2015.62.5764

Why Gleason 6 Prostate Cancer May Not Need Immediate Treatment (2)

By Mark Scholz, MD
Mark Scholz, MD, is a board-certified oncologist and expert on prostate cancer.

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Why Gleason 6 Prostate Cancer May Not Need Immediate Treatment (2024)

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.

Should prostate cancer be treated immediately? ›

Immediate treatment may not be necessary

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

How often does Gleason 6 progress to 7? ›

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.

What happens if you don t take treatment for prostate cancer? ›

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.

What is the life expectancy with a Gleason score of 6? ›

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%.

Can Gleason score 6 metastasize? ›

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.

How quickly does prostate cancer progress without treatment? ›

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.

How long can you delay prostate cancer 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 ...

What is the most successful prostate cancer treatment? ›

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.

Can Gleason score 7 spread to bones? ›

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.

Can Gleason 7 spread? ›

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.

What kills prostate cancer cells naturally? ›

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.

What are the chances of dying from untreated prostate cancer? ›

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.

At what age is prostate surgery not recommended? ›

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.

Is it better to have prostate removed or radiation? ›

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.

What is the difference between Gleason 6 and 7? ›

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.

What Gleason score is aggressive? ›

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.

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