Treatment options for gleason 6

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Hello,

I've recently been diagnosed with prostate cancer Gleason 6 (3+3) which I'm fortunate is low risk. I'm 67 and in otherwise good health. All my research indicates that Active Surveillance would normally be recommended but my urologist is pushing for me to have surgery, which I'd really rather avoid not because I'm squeamish but because of the side effects which have a significant chance of being permanent.

Is anybody else in a similar position of being encouraged to have a treatment they're not comfortable with?

  • Hello Duggie ( 

    I am pleased you have managed to find us and hope you find the group to be helpful.

    Whilst not having been in the situation you are in - anyone who knows me will know I am not a believer in Active Surveillance (it's not going away - deal with it whilst you can), I can only assume your urologist is a surgeon and touting for business. A Gleason 6 with a low PSA (I assume it's low) and confined to the prostate I would have thought you would be open to - Hormone Therapy / Radiotherapy and Brachytherapy. with a choice of any of the 3.

    I think you need to speak to oncology in your country of residence (I know you aren't in the UK) and see what treatments they have on offer.

    I do hope this helps - but it's only my personal opinion - I am sure others will be along soon.

    Feel free to ask any questions, nothing is to trivial.

    Best wishes - Brian.

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  • Hi DG

    As Brian has said, a surgeon pushing for business, often happens.

    AS is a possibility if PSA lowish and contained, prob the case here.

    Do take a look at Radiotherapy or Brachytherapy as am alternative cos they are relatively easy with no long lasting side effects which u can get with surgery although obviously not everyone does have them

    Best wishes 

    Steve 

  • Yes I also feel as if being pushed to the surgery route which I’m not comfortable with so am looking at other options as per my recent thread , if I am right yours is the lowest grading so certainly wouldn’t be rushing into anything , all,the best 

  • Hello Duggie ( 

    The information that you have provided is quite limited, but on the basis of that limited info the default way forward, at least in the UK, would be AS.   

    One option, if you have not already done this, is to get as much as possible in writing, including the rationale supporting your urologist's recommendation, and then get a second opinion.

    BTW, I don't think that anyone is ever completely comfortable with the prospect of a prostatectomy, with its risk of permanent side effects, even if it is actually the best option for them.

    Kind regards, Peroni.

  • Hi  and welcome. I don't know whether you have come across the treatment pathway flow chart (section 2) which suggests different pathways depending on your particular stats.

    https://prostatecanceruk.org/about-us/projects/best-practice-pathway/

    There are also very informative videos by Dr Mark Scholz which you might want to dip into, especially this one on active surveillance for Gleason 6.

    https://youtu.be/a0sjUallZQU?si=eJm-gUkLDeuEEKbU

    The takeout is make sure you do have Gleason 6 and no other risk factors before you make any decisions.

  • Hi Duggieboy

    I was diagnosed with Gleason 6 eight years ago and I've been on active surveillance since then. During those eight years I have seen many consultants, paid for by Bupa, and almost all offered me treatment. I decided against treatment because my biopsy in 2017 was such a bad experience and I have suffered with prostatitis ever since. I don't want any un-necessary intervention.

    The video by Dr Mark Scholz which Alwayshope sent a link to is excellent.  

    Best wishes.

  • Thanks Brian, everybody’s feedback has been great, really useful. I’m British but have lived in Brazil for a long time, with private health care which is perfectly up to date technically but is less “consultative” so on this issue I felt I needed a bit of homely UK perspective. My PSA is 4. It may be partly that the surgeon is trying to sell me treatment but his official reason is “better safe than sorry, nip it in the bud”, which I get. I’ll be seeking a second opinion from an oncologist and take it from there.

  • Glad I'm not the only one feeling pushed, it's reassuring to know others feel the same!

  • You're so right, which is why I want to be absolutely sure in my own mind that it's the right treatment before having it done.

  • Really useful links, thanks very much