How many Gleason 6 diagnoses turn out to be higher grade cancer?

Hi Andy

I think quite unusual for Gleeson to go up a notch, probably the more important point is how the tumour is growing which it often does even on a Gleeson 3+3.

I was a Gleeson 3+3 and tumour size went from 3mm to 13mm in 4 years.

So u will probably have to have treatment at some stage but just depends how quickly it grows.

U could certainly leave a few months to see how it goes, if u go on AS make sure u have regular PSA and yearly MRI.

Best wishes 

Steve 

Hello Andy B24 

I can't comment on Gleason 6 but only from personal experience.

I was diagnosed from a biopsy as a Gleason 7 - 10 months later the "chips"  removed from my prostate for my TURP operation turned out on examination to be a Gleason 9. So I went from a 7 to a 9 in 10 months. (Click on my name or avatar to read my journey).

Again, my personal thoughts would be to get it sorted. Yes, it's there and it's not going away. Just to remind you when you speak to your team, surgery isn't the only option - there's also HT/RT and Brachytherapy.

I do hope this helps.

Best wishes - Brian.

There are two aspects to this:

1) How accurate is the original diagnosis, and subsequent monitoring?

2) How the cancer grows and changes.

Prostate cancer diagnosis are not very accurate. The way we find out the accuracy is when a patient has a prostatectomy, the prostate goes off to the lab for more detailed pathology, and a new grading is given. In 40% of cases, this is different from the original diagnosis by MRI and biopsy, usually an upgrading, but occasionally a downgrading. The biopsy looks at such a minuscule proportion of the prostate that's it's easy to miss something more significant, although MRI before biopsy and guided biopsies (since 2018/2019) have made this better. Even the pathology when the whole prostate is on the bench isn't perfect - typically it looks at the surface of about 6 slices through the prostate, and it will miss anything which is only in between these surfaces. I think it's important to understand that neither way is perfect.

There is a theory that Gleason scores don't change, but what happens is that while you may have mostly 3+3 and such a tiny amount of 3+4 it's very unlikely to be hit by a biospy, this 3+4 might grow, and increase it's chance of being hit in later biopsies. Downgrading in a subsequent biopsy is even harder to understand, and I suspect this is where a later biopsy missed something which an earlier biopsy happened to hit, in which case downgrades should be ignored. Another explanation would be that the cells were sufficiently borderline that different pathologists would grade them differently.