Some low gleason PCs turn agressive, many do not, you just can't tell. What we do know is that about
75% never progress to the agressive stage in 7 years. I haven't seen any studies of longer duration so we really don't know yet what they will do in 20 years, but we know most men will die with PC than from it.
An agressive PC is anything with a gleason 8 or higher. A Gleason 7 is intermediate with a high probability of gettting aggressive in the future. Anything higher than a G6 needs to be treated. A G7, 4+3 is more agressive than a G7 3+4.
PSA doubling time is a good indicator of agressiveness, anything over 3 years doubling time is probably agressive or will turn agressive.
Total PSA is trickier; High grade Gleasons don't throw off a lot of psa. There are formulas that oncologists use to predict tumor volume using the prostate size, psa and Gleason score. A PSA over 10 with any gleason is a concern because once PC spreads beyond the prostate it starts to generate a lot of PSA.
Hope this answers your questions.
64 years old.
PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.
2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.
Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.
Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.
Scheduled for 5 weeks IMRT in July