Dad just diagnosed with Gleason 6 (3+3)

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New Member

Date Joined Apr 2011
Total Posts : 2
   Posted 4/6/2011 2:27 PM (GMT -6)   
My Dad was just diagnosed with PC. Can someone let me know what the best options for him are?

-Age: 58
-PSA jump in one year (02/2010 to 02/2011): 1.0 to 2.8
--12 cores
--1 came back Gleason 6 (3+3) with 40% involvement
--1 core adjacent to the Gleason 6 core came back high-grade PIN
--10 cores came back normal

Urologist is recommending watchful waiting (retest PSA levels in 3 months) or treatment, my Dad's choice. He's got an appointment with a surgeon and an oncologist this week.

I know this was caught really early and his prognosis for surviving is very excellent. However, what kind of treatments are the best in terms of side effects? Or is watchful waiting best? It's not as if this will "get better" on its own, so is treatment sooner rather than later a better option?

-Partial prostatectomy?
-External beam therapy?

I know they all have risks/pros/cons, but I was wondering what you gentlemen who've gone through treatment have experienced.

Elite Member

Date Joined Oct 2008
Total Posts : 25355
   Posted 4/6/2011 2:33 PM (GMT -6)   
welcome to hw,

we have lots of folks that are supprting their dad's pc. sounds like his numbers put him in the early stages. we have several men with good seeding experience and external beam rad as their primary treatment.

taking the time, as you show above, is a wise thing to do at this point. please ask all the questions you, no dumb questions here. we are here to help you and your dad.

i had open surgery and salvage radiation, if you have any questions in those areas, be happy to help you

good luck to you and your dad

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 2/11 1.24
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 9/10,

Veteran Member

Date Joined Sep 2010
Total Posts : 2648
   Posted 4/6/2011 2:48 PM (GMT -6)   
It's always a good thing to find the cancer early.  You need to emphasize to his doctor that you want to be fully informed of every treatment option:  from active surveillance, to surgery, to brachytherapy, to external beam radiation, and so on.
There has been a lot of discussion here lately about active surveillance (AS) for low-risk cancer found early, and it's generally felt that many urologists are not doing a good job of acquainting their patients with the AS option, so you might want to press him on that point.
I myself had surgery, but my case was a bit more advanced than your father's; also, my prostate was quite large, which ruled out brachytherapy (seed implantation). 
I think you'll find there are many treatment options, each with excellent success rates.  Now's the time to read, read, read and study those options to see which one best suits your father's particular situation.  You'll find men on this site who have experienced all the various treatments, and all can share their experiences and offer their suggestions.  Also, seek out the very best physicians you can find, no matter which treatment option you eventually choose.  You want to make your first shot at this a good one.
Your local library probably has many, many books on prostate cancer and its treatment.  You can also find at the top of our topics page a list of books that members here have found particularly helpful. 
Good luck.  I'm glad you found this site.

Regular Member

Date Joined Sep 2010
Total Posts : 148
   Posted 4/6/2011 3:47 PM (GMT -6)   
Show your Dad this site and ask him to post. This place is thereputic. Each man and his family have to come to thier own decision. Mine was prosectomy when my PSA hit 10.8. 
6 months ago I had cancer. Now at this moment my Dr can't find it and my prognosis is good that something else will kill me. Hopefully at a ripe old age.
It is a huge change to your lifestyle. Read the books listed in the first posts. I liked Dr Patrick Walsh's book. Best of luck.
Age 48 w/diagnosed
10/06 PSA 3.0
11/06 PSA FREE %13.2
10/07 PSA 3.4
12/07 Biopsy-neg
1/09 PSA 4.6
6/09 psa 5.8
2/10 psa 8.7
7/10 PSA 10.8
8/2010 3rd biopsy GG 3+3=6, one of eight cores -2%
Lap 10/22/10 Dr. Troxel
Path- Neg Margins, Gleason 6, Nerves spared, 85 gm
Jan 20, 1 pad/day psa < 0.1, ed an issue

Veteran Member

Date Joined Nov 2009
Total Posts : 1095
   Posted 4/6/2011 3:52 PM (GMT -6)   
My dad had prostate cancer. He appreciated my help with research, learning, etc. I imagine your dad will too. It is an important time to have supportive family members. With those statistics, he is likely going to be a good candidate for a variety of treatments, including surgery, external radiation, seeds, or perhaps a combination of treatments. And maybe AS too, if he has the mindset for that. I think the best advice is to talk with a really excellent surgeon, with deep experience, and get his (or her) advice. Then talk with a really excellent radiation oncologist, who specializes in prostate cancer and has treated many hundreds of prostate cancer patients, and get that doc's advice. Ideally, in my opinion, the doctors would not be affiliated with the same institution (so they don't feel compelled by relationships or institutional biases to agree with one another, or to pull punches). Your dad may get different advice from the different docs (understandably, each may favor his/her own specialty). But through the discussions he will learn alot. Maybe you or another close relative could come with him to these appointments. It is probably the case that very substantial expertise and deep experience is a more important driver of the ultimate outcome than the kind of treatment selected -- so get a real expert, not someone in the middle of the pack. Best wishes, Medved.

Veteran Member

Date Joined Jul 2010
Total Posts : 3596
   Posted 4/6/2011 4:09 PM (GMT -6)   
There is another Gleason 6 thread running at the moment with over 100 posts so far..You can probably learn a lot from that thread as it is very similar to your Dad's situation..
Age 68.
PSA age 55: 3.5, DRE normal.
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 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

Forum Moderator

Date Joined Sep 2008
Total Posts : 4052
   Posted 4/6/2011 4:22 PM (GMT -6)   
Dear Lannister:
Welcome to HW but I'm sorry you have to be here.  I agree with Fairwind.  Rather than repeat in your thread...please refer to the several threads started by Gleason 6 and maybe the one by I used to be a fish.  I think these will answer many of your initial questions.
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:

Veteran Member

Date Joined Jan 2011
Total Posts : 929
   Posted 4/6/2011 5:27 PM (GMT -6)   

Sorry about your dad’s diagnosis, but welcome to the site.  I’ve gotten a lot of good information, encouragement, and support from the people here.  They are very knowledgeable and caring.


I’ve got numbers similar to your dad’s although my PSA is higher.  This is low-risk slow growing cancer.  I’ve been given the following treatment options and told that I would do well with any of them: surgery, brachytherapy, IMRT, and AS.  Don’t rush into a treatment decision; your dad has time to learn about PC, and get some second opinions.  I agree that Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer is an excellent book and a good starting point.  Have him talk with other men who have had treatment; I found that very reassuring.  It’s good that he already has appointments set up to talk about his options.  When he goes for these consults, he should have a list of questions and take notes.  It would be good if someone could go with him.  He might also consider recording the conversation (with the doctor’s permission) as you can’t write down everything.  I wish I had done this. 


I would also encourage your dad to get a second opinion on the biopsy slides to make sure it’s Gleason 6.  The experts most often mentioned on the forum are Dr. Epstien at Johns Hopkins and Bostwick Labs.  My slides got slightly upgraded; I stayed at Gleason 6, but the percentage of cancer went up.  I’ve also heard of the pathology results being downgraded.


Good luck.


Age 53
Diagnosed Dec 2010
PSA 5.3
Biopsy: 50% in 1 of 12 cores, Gleason 6
PSA 5.6
RRP scheduled for 6/6/2011

New Member

Date Joined Apr 2011
Total Posts : 1
   Posted 4/6/2011 6:54 PM (GMT -6)   
This is lannister's Dad. Just lost 20 minutes of thought process when my browser crashed. Sigh. Anyway, surprisingly little effort to reconstruct my thoughts, and in less words:

The numbers are as reported. The Dr. originally recommended AS (3 mo repeat PSAs), but noted that many are not comfortable with that approach. I don't like that either. Given my age and data, the prognosis is excellent (given any of the mainstream treatments) for non-recurrence for the benchmark 15-20 years. The major factors are the potential side effects and their relative probabilities of occurrence. Again, my (relatively) young age argues for good outcome on the side effects. We'll see...

Seeing a radiotherapist tomorrow, and surgeon mid-next week. Initially leaning towards "robotic", laproscopic surgery route, with "seeded" radiation therapy a distant second. The practice is large (~50) with a number of sub-specialists. The Dr. is chief of urology at the local hospital, FWIW.

Feeling a bit shell-shocked (who wouldn't be?), but the visit today was quite encouraging, and I have an active life to continue leading, with large projects at work to strategize, and trips to take on business and pleasure. As they say in "Spamalot", "He's not dead yet." Sorry if any offense is taken here.

For the record, lannister's math is not perfect; I'm "only" 57...

Oh, the chat's open...

Veteran Member

Date Joined Feb 2011
Total Posts : 4093
   Posted 4/6/2011 8:10 PM (GMT -6)   

I think you're making a wise choice and your logic makes perfect sense to me.

I can only tell you that I went through robotic recently and everything went really well. Although there can be issues with urinary control and potency, I and many others have none or in some cases mild side effects that diminish with time.

I think finding a great surgeon, ideally one who is also an oncologist is critical. Skill and experience of doctor is second to nothing in my opinion.

Like you I was in the middle of a major project (setting up an office 5000 miles away) so it was critical to choose something that would not interfere with it if at all possible. It didn't.

Radiation is also very effective. It didn't make sense for me, but most of the specialists I spoke with suggested that in my case it would also be effective.

There is a site called Yana which is great because you can read the journeys of hundreds of cancer patients.

Feeling shell shocked is putting it mildly, but it gets better and easier on a daily basis. In my experience, and from what many others ahve also told me, the first few weeks are the hardest part of this journey.

Feel free to email me if you want details about the surgery and good luck.

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 4/6/2011 9:05 PM (GMT -6)   
Welcome to the site. I loved the reference to the monty Python stuff. I saw the show here in Las Vegas with John Hurley playing the lead and it was great.

The others have given good advice across the board. I believe that the best way to a decision requires a slow methodical process that includes careful examination of the information. To get information your father has started well be seeing another oncologist. I also recommend that if a live support group is close by to give up some time and go to it. There is usually so much valuable information at them. you can go to and select the "Find a Chapter Near You" button on the bottom half of the page. I run one of those groups but first I had to be there as a patient trying to get information. What can be better there is the possibility of watching presentations and interacting with the presenters.

Here is a link that will provide various ways to approach prostate cancer with conventional therapies. It's important to note that the fact that his doctor has stated he can just watch things for now means there is plenty of time to sort through this stuff...

Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.


John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4171
   Posted 4/6/2011 9:20 PM (GMT -6)   
L's dad,
Your urologist s giving you some good advice. Indications are you have low risk PC and the only troubling issue is the rapid rise in psa. This rise could be due to a host of other issues so getting another psa test in 3 months is a good idea. The wait will not be an issue, because you have most likely had this for 5 to 10 years and 3 more months of waiting and learning will not make a difference.
AS is a viable option that is gaining wide acceptance, if you meet the criteria which can be found on the John Hopkins or the PCRI web sites. The best book for a good explanation of AS and it's safety is "Invasion of the Prostate Snatchers" by Dr Mark Scholz, a noted Prostate Oncologist.
All treatment options have similar cure rates in the low risk catagory, so concentrating on the side effects of the different choices would be a wise course of action.
Good luck in your journey.
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 Nov 2010
Total Posts : 259
   Posted 4/7/2011 6:23 AM (GMT -6)   
Sorry to hear about your dad.

I am also a Gleason 6 and elected to go with surgery. I'm only 5 weeks out but not happy with the incontinence and ED. Six months from now I could have a change of mind. But as it stands, if I had a do over, would probably go with the seeds.
2009 PSA 2.2
2010 PSA 3.2
Biopsy 24 cores 3 positive
Gleason 3 plus 3
Robotic Surgery March 3, 2011 @ 6 am
Cath removal scheduled 3/17/11
Still Leaking like a Japanese Reactor 04/05/11
Horrible ED
Not at all happy with side effects

Veteran Member

Date Joined Feb 2011
Total Posts : 4093
   Posted 4/7/2011 6:42 AM (GMT -6)   
I'm sorry to hear that Viper. How is it affecting your workouts? Have you spoken to your doctor? Started taking the ED pills?

5 weeks is really early, you could and probably will see big improvements in next few months. They don't want you even getting erection for first 4 weeks post surgery.

New Member

Date Joined Apr 2011
Total Posts : 2
   Posted 4/7/2011 7:17 AM (GMT -6)   
lannistersdad said...

For the record, lannister's math is not perfect; I'm "only" 57...

Dorp! Color me embarrassed...58 this summer, I mean!
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