Whether or not Gleason 6 cancer ever metastasizes depends on where you stand in time to look at it and, thus, which way you are looking -- ahead or back.
What seems to be true is that the Gleason Type 3 cells -- as in Gleason 6(3+3) -- are incapable of establishing distant metastases. They don't cast off into the blood stream or the lymphatic system and take root somewhere else. But...
The presence in the prostate of a Gleason 6 tumor doesn't guarantee that another higher grade lesion can't occur somewhere else in the gland. This is somewhat rare but it happens. What is much rarer -- so rare that there are doctors who aren't convinced it ever happens -- is when the same lesion that was Gleason 6 morphs into a higher grade tumor (one that can metastasize.)
So, if you stand at the point of diagnosis, looking forward in time, and ask the question "Does Gleason 6 ever metastasize?" The answer is that it is rare but it can and does happen by one of three pathways: 1) the Gleason 6 diagnosis is in error and there are higher grade lesions that were missed in the biopsy; 2) After diagnosis a new tumor may form with a higher grade; and 3) the Gleason 6 lesion might undergo a further change and morph into a higher grade.
On the other hand, if you stand at the point where metastases are demonstrated and look backward in time the answer, in simple terms, is "No, it doesn't happen." Researchers have looked at men who developed metastases after having their prostates removed looking for any who had been Gleason 6 on their post-op pathology report. They then went back to the slides from those reports and had new reports produced by expert pathologists. In all but a couple of cases the new report showed a revised Gleason score higher than 6. Those few remaining cases of Gleason 6 metastasis were so few that they are more easily explained as lab errors or some other fluke.
Unfortunately, the point of diagnosis, where we know the least, is where most of the decisions have to be made.
J&D: You are stuck in the middle of my time-continuum. You know more about
things than you did at diagnosis but, sadly, you never get to know for sure until the fat lady sings. Still, being Gleason 6 at the margin is pretty hopeful and that <0.006g uPSA is good to see.
63 Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012: 1&2 neg, 3 pos 1/14 6(3+3) 3-4% (2nd
opn. 7(3+4)), 4 neg
DaVinci 6/14/12. "some" nerve sparing on left
Path: pT3a pN0 R1 GS9(4+5)
Pos margins on rt
24 mo ADT3 7/12 - 7/14
Adj IMRT 66.6 Gy 10/17/12-12/13/12
8/2012-3/2015: Incont., Trimix, VED, PSA<0.015.
AUS & IPP installed 3/5/2015Forum Moderator - Not a medical professional
Post Edited (PeterDisAbelard.) : 8/20/2017 9:52:02 AM (GMT-6)