What is a Gleason Score?
With prostate cancer, the Gleason Score is a measurement of how fast-growing and widespread the cancer is. After you have a prostate biopsy, a doctor called a pathologist looks at the sample of prostate tissue with a microscope.
When a pathologist looks at prostate biopsy tissue under a microscope, they look for details about the cancer cells. These details include how abnormal the cancer cells look, and how they may grow and spread. Very abnormal cells tend to grow more quickly, spread, and invade other tissues. This is referred to as aggressive. More details about this are in our risk stratification content.
Learn more about Gleason scores here.
What Does It Mean to Have Gleason Score 6 Prostate Cancer?
Gleason score 6 is also called Grade Group 1 prostate cancer. It is the least aggressive type of prostate cancer.
In recent years, medical experts have discussed whether Gleason score 6 cancer should be considered cancer at all. This is because it most often does not grow into nearby organs or spread to other parts of the body.
However, the most important question for men diagnosed with Gleason score 6 prostate cancer is whether the cancer grade found on the biopsy – a tiny sample of tissue – represents the cancer throughout the prostate.
Biopsy Results May Not Tell the Whole Story
A prostate biopsy only samples small areas of the prostate and the tumors in it. Doctors hope that these samples accurately represent the entire prostate and the cancer. But this is not always the case.
Studies of men who had their prostates surgically removed show that some men diagnosed with Gleason score 6 cancer on biopsy were found to have Gleason score 7 cancer when the entire prostate was examined after surgery.
The opposite can also happen. Some men who appear to have Gleason score 7 cancer on biopsy have been found to have Gleason score 6 cancer after the prostate is removed and examined.
In recent years, many urologists have adopted newer technologies to improve the diagnosis of prostate cancer. One of the most important advances is magnetic resonance imaging (MRI).
MRI scans can identify areas of the prostate that look abnormal. Doctors can then perform targeted biopsies of these areas. This increases the chance of finding the accurate traits of the cancer.
What Are Treatment Options for Gleason Score 6 Prostate Cancer?
Most men with Gleason score 6 prostate cancer are classified as having low-risk prostate cancer. However, other factors may increase the risk level, such as:
- A PSA level higher than 10 ng/mL
- More advanced cancer found during a rectal exam
For most men with Gleason score 6 prostate cancer, no additional testing is needed before deciding on treatment.
The treatment options include:
- Active surveillance
- Surgery
- Radiation therapy
Active Surveillance
Active surveillance means closely monitoring the cancer rather than treating it right away. This approach is based on the fact that only a small number of men with low-risk prostate cancer will develop disease that causes problems, such as:
- Growing large enough to cause urinary problems
- Spreading outside the prostate (metastasizing)
The American Society for Clinical Oncology (ASCO) recommends active surveillance as the best available care option for men with very-low risk prostate cancer (most men with Gleason score 6 prostate cancer). It is also the “preferable care option” for most men with low-risk prostate cancer.
Why Avoid or Delay Treatment?
Prostate cancer treatments, including surgery and radiation therapy, can cause side effects and complications. These may include:
- Urine leakage (incontinence)
- Erectile dysfunction (problems getting or keeping an erection)
- Trouble urinating
- Bowel problems
For some men, avoiding or delaying treatment can help maintain quality of life, as long as it does not increase the risk of the cancer becoming more serious.
Recent studies show that active surveillance is being used more often in the United States. However, it is used even more frequently in countries such as Canada, Sweden, the United Kingdom, and others.
What Happens If You Choose Active Surveillance?
Men who choose active surveillance are monitored regularly. Follow-up usually includes:
- PSA blood tests (often every 6 months)
- MRI scans, if one has not already been done
- A confirmatory biopsy (see below)
The confirmatory biopsy is more tissue taken after the original diagnostic biopsy. This second biopsy helps make sure that a more aggressive cancer was not missed during the first biopsy.
You can learn more about this in our article on active surveillance.
Choosing Treatment Instead of Active Surveillance
Active surveillance is the preferred approach for most men with Gleason score 6 prostate cancer. But some men may choose treatment after discussing their options with their family and doctors.
Treatment options may include:
- Surgery: Surgery is done to remove the prostate. This is called a radical prostatectomy. This procedure is often done using the da Vinci robotic platform.
- Radiation therapy: This may be done with a machine that directs radiation into the prostate. This is called external beam radiation therapy (EBRT). Or it may be done with small radioactive pellets placed inside the prostate. This is called brachytherapy.
For men with Gleason score 6 prostate cancer, hormone therapy (androgen deprivation therapy, or ADT) is usually not needed when radiation therapy is given.
Talking With Your Healthcare Team
The best treatment for you depends on these factors:
- Your Gleason score
- The amount of cancer found
- Your age and overall health
- Your personal preferences
Talk with your doctor about your Gleason score, test results, treatment options, and preferences. Together you can decide the best type of treatment for you.