The JAMA paper is nothing new. Here are a few others I found after I was diagnosed GS6 and before I decided on treatment:Gleason Score 6 Adenocarcinoma: Should It Be Labeled As Cancer?
Do adenocarcinomas of the prostate with Gleason score (GS) ≤6 have the potential to metastasize to lymph nodes?
Words of Wisdom Re: Do Adenocarcinomas of the Prostate with Gleason Score (GS) =6 Have the Potential to Metastasize to Lymph Nodes?
The first is particularly good at laying out both sides and, personally, I found the arguments for keeping the label of "cancer" particularly compelling.
And while I did take a lot of comfort from the overwhelming evidence that true
GS6 is usually indolent and rarely fatal I felt and continue to think that the discussion is moot as long as we have no good way to ascertain true GS aside from radical surgery.
In my case being only 40 years old, I felt that the stakes were too high to risk that the grade 3 cells may eventually de-differentiate into higher-grade disease (which no one really knows) let alone risk the ~30% chance that the biopsy missed some grade 4 disease.
Moreover even though GS6 may virtually never spread distantly it clearly has the potential to spread locally affecting nerves, bladder, rectum, etc. and with stage 2 tumor and PNI, I felt that the chance of not eventually needing treatment during my life was very low and that such treatment, if delayed, would be much more likely to fail oncologically and/or have serious complications. I think this is a very important point that seems to be missed with the myopic focus on potential for distant metastasis as the only threat of the disease.
Jan '13: PSA 1.23, small nodule on DRE (1st screening @ age 40)
Mar '13: Biopsy 2 of 12 cores GS 3+3: rt mid 10% and rt apex 20% w/ PNI+ Stage cT2a
Apr '13: Biopsy confirmed by Dr. Epstein @ Hopkins
open RRP by Dr. Burnett @ Hopkins. Both nerves spared.
Final Path: GS 3+3, organ confined (tumor extent moderate), SV and 11 nodes all negative (pT2a), negative margins!
PSA: 0.01 @ 6 wks
Post Edited (njs) : 7/29/2013 9:06:40 PM (GMT-6)