Real Gleason 6 does not metastasize (?)

[drmoose]

Increasing strong evidence that a "real" Gleason 6 is NOT cancerous e.g. not at risk for metastasis.

Comments? I guess determining an accurate Gleason score is not so trivial.

[Tall_Allen]

Here's a more nuanced POV:

prostatecancer.news/2017/11...

[drmoose in reply to Tall_Allen]

Thanks!

I guess the real issue is there is no way to know - with 100% certainty - if all of the lesion is G6. So always some residual risk there.

[Tall_Allen in reply to drmoose]

There are several routes to progression, as you see in the article. Missing higher grade cancer is just one.

[Adf2529]

Over the course of two years, my low volume GS6 progressed to GS7. Two biopsies read by Johns Hopkins. I sought treatment.

[Gardenpests]

Over 2.5 years and 3 biopsies my GS6 progressed to GS7 and I sought treatment. Pathology T3a N0.

[Gpinkk]

I am a little confused because these are treated patients with Gleason six patients. which means they have had surgery? Is this surgery a prostatectomy or biopsy proven Gleason six.? What about untreated Gleason six?

[drmoose]

There is a trend to consider surgery or radiation of a Gleason 6 as "overtreatment" e.g. it is actually pre-cancerous. Sometimes even called "benign".

But as Tall_Allen nicely pointed out at the beginning of this thread - there is risk that something higher is missed, or that there is progression to G7 or higher.

healthunlocked.com/api/redi...

One of the sobering learnings of my last year has been the relatively inadequacy of mainstream diagnostic tools - random biopsies (aaggghhh - do an MRI-guided one!) and 3T mpMRI's (a HUGE advance but still leaving "pesky" issues like EPE extra-capsular extension open and vague).

In the end - highly personal and depends on your ability to manage risk and uncertainty. I think we all understand the primal fear in hearing "you have cancer" and the immediate reaction of "yes get rid of it" when offered surgery (or radiation).