Question about Gleason 6

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Regular Member

Date Joined Sep 2009
Total Posts : 462
   Posted 11/19/2010 12:43 PM (GMT -6)   
I am just curious to know if you can get terminal mestastic PC with Gleason 6, or does it need to first change to Gleason 7, then to 8, then 9, and finally 10 before you actually die?
Age 56, Biopsy 6/2007 - PSA 4.5, 2 of 12 with  <5% cancer Gleason 6
Surgery 9/2007 Strong Memorial,  Rochester  NY with Dr. Jean Joseph (1300 plus surgeries)
 Path - Negative margins, cancer in 20% examined tissue, Gleason 6
 Post Op - No ED issues, full erections without drugs,  used 5-7 pads a day for 3 months. Now dry except for stress leaks now and then.
 All post op psa's <.04

Regular Member

Date Joined Aug 2010
Total Posts : 154
   Posted 11/19/2010 3:27 PM (GMT -6)   
What in the world are you worrying about? With stats like yours, you should be celebrating and enjoying life to its fullest. 3 years post surgery, no issues and still <.04? Read some of the other posts on this site and you will discover when it is time to start planning other options. In the mean time, sit back and take it easy.
PSA at Dx 105 at age 68, 4/04. ADT (Lupron only), RRP, 5/04. Gleason 4+5=9, Staged pT3c N0 MX, 3D rad, 40 treatments, 8/04. PSA 1/05 <0.01. ADT till 7/07. PSA 0.03 12/08, 0.07 4/09, 0.13 8/09, 0.19 12/09, 0.30 4/10, 8/10 0.41. Will start ADT3 after PSA reaches 1.2.

Regular Member

Date Joined Oct 2010
Total Posts : 21
   Posted 11/19/2010 3:28 PM (GMT -6)   
I am by no means an expert or even close to one but I was daagnosed with Gleason 3+3 at biopsy and Stage T1c with a PSA of 3.2 at age 58. Biopsy showed 7 of 12 samples showed 5%-40%.
The pathology report came back with Gleason upgraded to 3+4 but with clear margins. They did note though that the surgeon had taken a little more out around the prostate and that the cancer was just on the verge of escaping the gland.
So can a 6 be of concern to bigger issues? Normally, from all of my reading, my answer would be not likely. But yet, I almost crossed that threashold. So my message would be not to worry about it too much until you get the pathology report (assuming you have surgery) and then take the next steps as necessary.

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 11/19/2010 3:41 PM (GMT -6)   
I maybe wrong but I think the Gleason would only be relevent on how soon the cancer could matatisize without treatment. A Gleason 6 could take 20 to 30 years, and a Gleason 10 in as little as 2 years. One member here has a Gleason 7 and has bone mets and currently under HT treatment. Another member has a Gleason 7 and was just treated for bone mets after surgery and that was within a year...but most likely he had the mets prior to the surgery.

The gleason normally won't change over time from what I understand (don't quote me as I may be wrong) and mets normally won't occur until the tumor burden is quite high, usually above 20 ng/l
You are beating back cancer, so hold your head up with dignity


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Veteran Member

Date Joined Jul 2010
Total Posts : 3596
   Posted 11/19/2010 3:54 PM (GMT -6)   
Gleason 6 seldom metastasizes..It's not impossible, but it's pretty rare, maybe a 10% chance? If it does metastasize, it's usually to a large bone and that cancer also grows slowly and it can be successfully treated with radiation or hormone therapy..

Very few men die from prostate cancer that began as Gleason 6 ...

Gleason grades seem to be pretty stable. What begins as a G-6 usually stays that way even if the disease progresses..But not always..There are cases where G-6 tumors seem to mutate into a more aggressive form..This makes "Active Surveillance" tricky business..

The progression of this cancer is almost impossible to predict on an individual basis..Every case is a little different.. Good Luck..
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT, Dec

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4171
   Posted 11/19/2010 4:14 PM (GMT -6)   
As Fairwind mentioned, there are very few deaths from a G6 cancer even if it matastizes. The death rate is bout 1.7% and those patients had a very agressive varient of a G6. It is rare that a G6 would turn into a G8; given time it can turn into a g7.\
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Regular Member

Date Joined Mar 2010
Total Posts : 479
   Posted 11/20/2010 10:01 AM (GMT -6)   
NY Sooner:
You are most certainly NOT asking about yourself. Your situation has been dealt with permanently.
G6 can become metastatic if untreated. This occurs in one of several ways. The tumor can grow, in place, until it spreads to surrounding tissue. It can also develop, over time, to a more aggressive type, a G 7 and above and thus infiltrate widely. This is a natural progression of the disease. For men who die of their cancer, the G score of the remaining disease is nearly always G 8-10 by the time of demise. This is called the de-differentiation of the diseased cells. They become less normal and more primitive, as the cells which remain alive after a series of treatments is made up more and more of the most damaged cells. A kind of reverse evolution.The good news is that even if initially untreated, the G6 will respond for long periods to hormone and radiation treatments and survival is usually greater than for those with higher G scores at diagnosis.

Elite Member

Date Joined Oct 2008
Total Posts : 25355
   Posted 11/20/2010 10:13 AM (GMT -6)   
"NY Sooner:
You are most certainly NOT asking about yourself. Your situation has been dealt with permanently"

Tar, while NY Sooner PC dx, surgery, pathology, and even post surgical PSA's are great, so far, you shouldnt be so dogmatic in your
accessment. He could still, however unlikely, have recurrance at some future point. There are no gurarantees in this biz. We have
guys that are strong Gleason 8/9 T-3, that are still squeaky clean sometime out, and we have others with clean pathology that get banged up with almost instant recurrance.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Regular Member

Date Joined Mar 2010
Total Posts : 479
   Posted 11/20/2010 1:34 PM (GMT -6)   
He had indolent cancer. His biopsy figures were well within the Active Surveillance guidelines. He chose surgery at a top rank institution with one of the very best surgeons available. His pathology was clear and clean. His more than two years of undetectible psa means his chance of recurrence is vanishingly small. I believe he is cured and his pathology and psa numbers support this view. I believe his doctor will say the same. I see him as among the 9,999 and not the 1 in 10,000.
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