The Gleason Score is a grading system used to assess prostate cancer cells and determine their aggressiveness. This article focuses on Gleason 6 prostate cancer, clarifying its meaning and implications for patient health.
Understanding the Gleason Score
The Gleason Score, developed by pathologist Donald Gleason, grades prostate cancer aggressiveness based on the microscopic appearance of cells from a biopsy. Pathologists assign primary and secondary patterns (1 to 5) based on cell organization. These patterns are added to determine the final Gleason Score, typically ranging from 6 to 10 for diagnosed cancers. Scores below 6 are not considered cancerous. A higher combined score indicates more aggressive cancer.
Gleason 6: Characteristics and Risk
Gleason 6 prostate cancer is the lowest grade within this scoring system, often classified as low-risk or very low-risk disease. The cells in Gleason 6 tumors are well-differentiated, meaning they still resemble normal prostate cells to a significant degree. These tumors grow very slowly and have an extremely low propensity to spread beyond the prostate gland. On its own, and with appropriate management, Gleason 6 prostate cancer is rarely a direct cause of death. Due to its indolent behavior, some medical professionals and patient advocates have even debated whether it should be classified as “cancer,” though it remains so for now.
Management Approaches for Gleason 6
Active Surveillance is a common management approach for Gleason 6 prostate cancer. This strategy involves close and regular monitoring of the cancer rather than immediate aggressive treatment. Active Surveillance typically includes periodic Prostate-Specific Antigen (PSA) blood tests, annual digital rectal exams, and sometimes repeat biopsies or advanced imaging like multiparametric MRI. The rationale behind this approach is to avoid the potential side effects of treatments such as surgery or radiation, which can include incontinence or erectile dysfunction, when the cancer is unlikely to cause harm. A less intensive monitoring approach called “watchful waiting” might be considered for older men or those with other serious health conditions, but Active Surveillance is generally preferred for the broader population with Gleason 6.
The Long-Term Outlook
The prognosis for men diagnosed with Gleason 6 prostate cancer is generally favorable. The vast majority of individuals with this diagnosis will not die from this specific cancer and often live long, healthy lives. While ongoing monitoring is part of the management plan, Gleason 6 typically does not progress to a more aggressive form. Many men undergoing Active Surveillance for Gleason 6 prostate cancer never require active treatment, affirming the effectiveness of this approach in managing the condition.