Table of ContentsView AllTable of ContentsGleason ScoreCharacteristicsMonitoring/TreatmentWhen Your Score Increases
Table of ContentsView All
View All
Table of Contents
Gleason Score
Characteristics
Monitoring/Treatment
When Your Score Increases
Gleason score 6 is the lowest grade of prostate cancer. This rating means that the prostate cancer is considered to be low- or very low-risk disease, or group 1.Most of these tumors are found during routine prostate cancer screenings.
Gleason 6 prostate tumors grow slowly and may never cause a problem—or even need treatment. Still, they should be monitored.
Noel Hendrickson / Getty Images
This article outlines what Gleason 6 prostate cancer means, why monitoring is important, when treatment may be considered, and questions you can ask your urologist if you’ve been diagnosed.
The Gleason Grading System
Screening for prostate cancer involves theprostate-specific antigen(PSA) test and adigital rectal exam. If results are suspect, your healthcare provider may recommend aprostate biopsy—the only way to confirm the diagnosis.
During a prostate biopsy, a urologist uses a small needle to remove tissue samples (usually 12) from different parts of the prostate. These samples—also called “cores”—are then sent to a pathologist so they can review each one under a microscope.
Your Gleason score is the sum of the two numbers that represent the most common types of tissue found in your biopsy. The first number in the equation is the most common grade present, the second number is the second most common grade. For example, if seven of your cores are grade 5 and five are grade 4, your Gleason score would be 5+4, or a Gleason 9.
What stage of cancer is Gleason 6?Gleason score helps determine which stage of cancer you have, but it has a different meaning. Gleason score describes how abnormal the tumor cells are and how likely they are to spread. Stage describes where the cancer is located and how far it has spread. It is possible to have a Gleason score of 6 with either stage I or stage IIA, which are found only in the prostate.
What stage of cancer is Gleason 6?
Gleason score helps determine which stage of cancer you have, but it has a different meaning. Gleason score describes how abnormal the tumor cells are and how likely they are to spread. Stage describes where the cancer is located and how far it has spread. It is possible to have a Gleason score of 6 with either stage I or stage IIA, which are found only in the prostate.
Today, pathologists typically only flag tissue samples that are grade 3 or higher, making 6 the lowest Gleason score.
In 2014, a revised grading system for prostate cancer—called Grade Groups—was established. This system builds on the Gleason scoring system and breaks prostate cancer into five groups based on risk.This can help make it easier to understand the Gleason score scale.
Prostate Cancer Grade GroupsGleason ScoreGrade GroupRisk GroupLess than or equal to 61Low/very low7 (3+4)2Favorable7 (4+3)3Unfavorable84High9-105Very highYour Gleason score tells your care team quite a bit, including:Whether cancer is present in your prostateHow quickly it is growingHow likely it may be to spread to other parts of your bodyThis helps you work with your urologist to make informed decisions about next steps.What Does Gleason 6 Mean?A Gleason score of 6 is different from other prostate cancer diagnoses because it means all the biopsy samples are grade 3 (3+3=6). Though the samples don’t look like normal tissue, no grade 4 or 5 samples were found.A Gleason score of 6 means that all of the tissue samples in your biopsy were grade 3. This means that the cells are not normal, but aren’t necessarily aggressive or causing a concern. Gleason 6 prostate tumors are:SmallConfined to the prostateNot causing any symptomsProstate cancers with a Gleason score of 6 are not usually considered serious. There are changes at the cellular level, but the prostate cancer is likely slow-growing and has a low-risk ofmetastasizing, or spreading to other areas of the body.This knowledge allows your healthcare provider to monitor you and see how your tumor changes over time.Cancer ControversySome experts say Gleason 6 prostate tumors should not be called “cancer” because of their low-risk nature and the fact that the term may cause some patients to be overtreated.This, however, runs counter to the stances of major medical organizations.Terminology aside, the bottom line is this: Though not all prostate cancers require active treatment right away, your healthcare provider can’t monitor a tumor if they don’t know it’s there.How Gleason 6 Prostate Cancer is TreatedIn the past, men with prostate cancer—regardless of whether it was aggressive or not—were almost always treated right away with a targeted therapy like surgery or radiation. However, in recent years, experts have revisited this “one-size-fits-all” approach to prostate cancer.Experts now understand that low-risk prostate cancer—like Gleason 6 tumors–may not need treatment right away. In fact, major medical associations, including the American Urological Association and the Society for Urologic Oncology, now recommend the use of active surveillance for low-risk prostate cancer.Watch and WaitThough it is sometimes called “watchful waiting,” active surveillance doesn’t mean that you do nothing but sit and wait. Instead, it means your healthcare provider will monitor your tumor over time with periodic PSA tests, digital rectal exams, and biopsies to see if it changes.Watching the tumor closely will allow your healthcare provider to step in when necessary so they can treat your tumor before it has a chance to spread to other parts of your body. Your urologist will work with you to determine how often each of these tests should be done to ensure that your tumor is being appropriately monitored.Studies have shown men with low-risk disease on active surveillance continue to show good results even after a decade or more.Postponing therapy until it’s necessary allows you to maintain your normal lifestyle and avoid potential side effects of prostate cancer treatment, such as incontinence or erectile dysfunction.Monitoring Your Gleason ScoreIf your Gleason score changes while you’re on active surveillance, it’s time for a discussion with your urologist to better understand the situation.You may find it helpful to ask these questions:In what way did my Gleason score increase?Remember that the numbers that comprise your Gleason score represent the two most common grades of tissue in your biopsy. Finding out which number increased is important to understanding how your tumor has changed. A change in your first number (for instance, a new Gleason score of 4+3) means that most of your tissue samples are now grade 4 (higher risk). A new Gleason score of 3+4 means that grade 3 (low risk) is still the most prominent type of tissue in your biopsy.How does this impact my risk level?Your risk level is based on the distribution of grade 3 and grade 4 samples. A Gleason 7 (3+4) has a more favorable risk level than a Gleason 7 (4+3).Is it time to consider active treatment?It can be unsettling to find out that your prostate cancer has changed or may be getting worse. However, even if your urologist recommends staying on active surveillance, it may bring you peace of mind to better understand at what point you’ll need to consider other options.SummaryGleason 6 prostate cancer is one of the most commonly diagnosed types of prostate tumor. It is the most low-risk type of the disease.Because Gleason 6 is not likely to be aggressive or spread rapidly, active surveillance—monitoring for changes—is often used to watch the cancer over time. This allows a patient to put off treatment, such as surgery or radiation, until it is absolutely necessary.
Your Gleason score tells your care team quite a bit, including:
This helps you work with your urologist to make informed decisions about next steps.
What Does Gleason 6 Mean?
A Gleason score of 6 is different from other prostate cancer diagnoses because it means all the biopsy samples are grade 3 (3+3=6). Though the samples don’t look like normal tissue, no grade 4 or 5 samples were found.
A Gleason score of 6 means that all of the tissue samples in your biopsy were grade 3. This means that the cells are not normal, but aren’t necessarily aggressive or causing a concern. Gleason 6 prostate tumors are:
Prostate cancers with a Gleason score of 6 are not usually considered serious. There are changes at the cellular level, but the prostate cancer is likely slow-growing and has a low-risk ofmetastasizing, or spreading to other areas of the body.
This knowledge allows your healthcare provider to monitor you and see how your tumor changes over time.
Cancer ControversySome experts say Gleason 6 prostate tumors should not be called “cancer” because of their low-risk nature and the fact that the term may cause some patients to be overtreated.This, however, runs counter to the stances of major medical organizations.Terminology aside, the bottom line is this: Though not all prostate cancers require active treatment right away, your healthcare provider can’t monitor a tumor if they don’t know it’s there.
Cancer Controversy
Some experts say Gleason 6 prostate tumors should not be called “cancer” because of their low-risk nature and the fact that the term may cause some patients to be overtreated.This, however, runs counter to the stances of major medical organizations.Terminology aside, the bottom line is this: Though not all prostate cancers require active treatment right away, your healthcare provider can’t monitor a tumor if they don’t know it’s there.
Some experts say Gleason 6 prostate tumors should not be called “cancer” because of their low-risk nature and the fact that the term may cause some patients to be overtreated.
This, however, runs counter to the stances of major medical organizations.
Terminology aside, the bottom line is this: Though not all prostate cancers require active treatment right away, your healthcare provider can’t monitor a tumor if they don’t know it’s there.
How Gleason 6 Prostate Cancer is Treated
In the past, men with prostate cancer—regardless of whether it was aggressive or not—were almost always treated right away with a targeted therapy like surgery or radiation. However, in recent years, experts have revisited this “one-size-fits-all” approach to prostate cancer.
Experts now understand that low-risk prostate cancer—like Gleason 6 tumors–may not need treatment right away. In fact, major medical associations, including the American Urological Association and the Society for Urologic Oncology, now recommend the use of active surveillance for low-risk prostate cancer.
Watch and Wait
Though it is sometimes called “watchful waiting,” active surveillance doesn’t mean that you do nothing but sit and wait. Instead, it means your healthcare provider will monitor your tumor over time with periodic PSA tests, digital rectal exams, and biopsies to see if it changes.
Watching the tumor closely will allow your healthcare provider to step in when necessary so they can treat your tumor before it has a chance to spread to other parts of your body. Your urologist will work with you to determine how often each of these tests should be done to ensure that your tumor is being appropriately monitored.
Studies have shown men with low-risk disease on active surveillance continue to show good results even after a decade or more.
Postponing therapy until it’s necessary allows you to maintain your normal lifestyle and avoid potential side effects of prostate cancer treatment, such as incontinence or erectile dysfunction.
Monitoring Your Gleason Score
If your Gleason score changes while you’re on active surveillance, it’s time for a discussion with your urologist to better understand the situation.
You may find it helpful to ask these questions:
Summary
Gleason 6 prostate cancer is one of the most commonly diagnosed types of prostate tumor. It is the most low-risk type of the disease.
Because Gleason 6 is not likely to be aggressive or spread rapidly, active surveillance—monitoring for changes—is often used to watch the cancer over time. This allows a patient to put off treatment, such as surgery or radiation, until it is absolutely necessary.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Cancer Society.Your prostate pathology report: cancer (adenocarcinoma).Gearman DJ, Morlacco A, Cheville JC, Rangel LJ, Karnes RJ.Comparison of pathological and oncologic outcomes of favorable risk Gleason score 3 + 4 and low risk Gleason score 6 prostate cancer: Considerations for active surveillance.J Urol. 2018;199(5):1188-1195. doi:10.1016/j.juro.2017.11.116Prostate Cancer Foundation.Gleason score and grade group.Icahn School of Medicine at Mount Sinai.Gleason grading system.Egevad L, Delahunt B, Srigley JR, Samaratunga H.International Society of Urological Pathology (ISUP) grading of prostate cancer – An ISUP consensus on contemporary grading. APMIS. 2016;124(6):433-435. doi:10.1111/apm.12533Epstein JI.Is Grade Group 1 (Gleason score 3 + 3 = 6) adenocarcinoma of the prostate really cancer?Curr Opin Urol. 2022;32(1):91-95. doi:10.1097/MOU.0000000000000945American Cancer Society.Prostate cancer stages and other ways to assess risk.Choyke PL, Loeb S.Active surveillance of prostate cancer. Oncology (Williston Park); 31(1):67-70.American Urological Association.Clinically localized prostate cancer: AUA/ASTRO/SUO Guideline.Tosoian JJ, Mamawala M, Epstein JI, et al.Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer.JCO. 2015;33(30):3379-3385. doi:10.1200/JCO.2015.62.5764
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Cancer Society.Your prostate pathology report: cancer (adenocarcinoma).Gearman DJ, Morlacco A, Cheville JC, Rangel LJ, Karnes RJ.Comparison of pathological and oncologic outcomes of favorable risk Gleason score 3 + 4 and low risk Gleason score 6 prostate cancer: Considerations for active surveillance.J Urol. 2018;199(5):1188-1195. doi:10.1016/j.juro.2017.11.116Prostate Cancer Foundation.Gleason score and grade group.Icahn School of Medicine at Mount Sinai.Gleason grading system.Egevad L, Delahunt B, Srigley JR, Samaratunga H.International Society of Urological Pathology (ISUP) grading of prostate cancer – An ISUP consensus on contemporary grading. APMIS. 2016;124(6):433-435. doi:10.1111/apm.12533Epstein JI.Is Grade Group 1 (Gleason score 3 + 3 = 6) adenocarcinoma of the prostate really cancer?Curr Opin Urol. 2022;32(1):91-95. doi:10.1097/MOU.0000000000000945American Cancer Society.Prostate cancer stages and other ways to assess risk.Choyke PL, Loeb S.Active surveillance of prostate cancer. Oncology (Williston Park); 31(1):67-70.American Urological Association.Clinically localized prostate cancer: AUA/ASTRO/SUO Guideline.Tosoian JJ, Mamawala M, Epstein JI, et al.Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer.JCO. 2015;33(30):3379-3385. doi:10.1200/JCO.2015.62.5764
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Cancer Society.Your prostate pathology report: cancer (adenocarcinoma).Gearman DJ, Morlacco A, Cheville JC, Rangel LJ, Karnes RJ.Comparison of pathological and oncologic outcomes of favorable risk Gleason score 3 + 4 and low risk Gleason score 6 prostate cancer: Considerations for active surveillance.J Urol. 2018;199(5):1188-1195. doi:10.1016/j.juro.2017.11.116Prostate Cancer Foundation.Gleason score and grade group.Icahn School of Medicine at Mount Sinai.Gleason grading system.Egevad L, Delahunt B, Srigley JR, Samaratunga H.International Society of Urological Pathology (ISUP) grading of prostate cancer – An ISUP consensus on contemporary grading. APMIS. 2016;124(6):433-435. doi:10.1111/apm.12533Epstein JI.Is Grade Group 1 (Gleason score 3 + 3 = 6) adenocarcinoma of the prostate really cancer?Curr Opin Urol. 2022;32(1):91-95. doi:10.1097/MOU.0000000000000945American Cancer Society.Prostate cancer stages and other ways to assess risk.Choyke PL, Loeb S.Active surveillance of prostate cancer. Oncology (Williston Park); 31(1):67-70.American Urological Association.Clinically localized prostate cancer: AUA/ASTRO/SUO Guideline.Tosoian JJ, Mamawala M, Epstein JI, et al.Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer.JCO. 2015;33(30):3379-3385. doi:10.1200/JCO.2015.62.5764
American Cancer Society.Your prostate pathology report: cancer (adenocarcinoma).
Gearman DJ, Morlacco A, Cheville JC, Rangel LJ, Karnes RJ.Comparison of pathological and oncologic outcomes of favorable risk Gleason score 3 + 4 and low risk Gleason score 6 prostate cancer: Considerations for active surveillance.J Urol. 2018;199(5):1188-1195. doi:10.1016/j.juro.2017.11.116
Prostate Cancer Foundation.Gleason score and grade group.
Icahn School of Medicine at Mount Sinai.Gleason grading system.
Egevad L, Delahunt B, Srigley JR, Samaratunga H.International Society of Urological Pathology (ISUP) grading of prostate cancer – An ISUP consensus on contemporary grading. APMIS. 2016;124(6):433-435. doi:10.1111/apm.12533
Epstein JI.Is Grade Group 1 (Gleason score 3 + 3 = 6) adenocarcinoma of the prostate really cancer?Curr Opin Urol. 2022;32(1):91-95. doi:10.1097/MOU.0000000000000945
American Cancer Society.Prostate cancer stages and other ways to assess risk.
Choyke PL, Loeb S.Active surveillance of prostate cancer. Oncology (Williston Park); 31(1):67-70.
American Urological Association.Clinically localized prostate cancer: AUA/ASTRO/SUO Guideline.
Tosoian JJ, Mamawala M, Epstein JI, et al.Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer.JCO. 2015;33(30):3379-3385. doi:10.1200/JCO.2015.62.5764
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.Cookies SettingsAccept All Cookies
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.
Cookies SettingsAccept All Cookies
