Can you die from Gleason 6 PC

From what Dr.Myers says regarding active surrvailance, about 1/3 of Gleason 6 insignificant cancer will progress, therefore they should be closely monitored. Whether they acquire Gleason 7, 8 or 9 pathology, I am not sure. Your stats seem excellent, I would not worry if I were in your place.

For organ confined G6 PCA it is death very-very-very rare. 

The last study I read showed that 3 out of 9,577 patients died after 15 years.  That is a 99.97% survival rate.  That study contained patients from 3 major medical centers.  Johns Hopkins had a study with 2526 patients who had organ confined G6 PCA and nobody died up to 15 years out.

Remember however, that in 2005 the Gleason grading system was changed making it harder to be a Gleason 6.  So, of those 3 that died in the previous study, may not have been graded a Gleason 6 today.   In the J.H. study originally they had 36 people that who were OC G6 that had BCR and upon review of their post op pathologies they found that 25 of them were actually up graded or upstaged and only 11 that had BCR were OC G6.  They then stated that none of those 11 people went on to develope metastatic prostate cancer or died of PCA.

So, yes people have died that were classified as OC G6, but today might be different.

I also read another study that says if your PSA <0.04 after 3 years your chance of recurrence drops to near 0.  In fact they felt you could move to PSA testing every 2 years and still be safe.

Dx @ 42yrsold PSA 2.76
Gleason 6 (6 out of 50 Cores positive - Small Focus Each)
open RP 10/08  Johns Hopkins
Post-op pT2 Organ Confined Gleason 6 (tertiary score 0)
<0.03 All PSAs (2/24/2012 last read)

Post Edited (ChrisR) : 4/18/2012 1:30:15 PM (GMT-6)

I wouldn't call 25,000-30,000 men dying every year in the U.S., as a small proportion of men dying from PC.

I agree, that with a low risk factored Gleason 6, and assuming it was correctly diagnosed, there would be little risk of dying from the cancer.

Note this chart from the American Cancer Society, it's talking about risks of developing and risks of dying from cancers with men:

http://www.cancer.org/Cancer/CancerBasics/lifetime-probability-of-developing-or-dying-from-cancer

It clearly shows Prostate Cancer as being the 2nd highest for men developing PC, and the 2nd highest for dying from it.  If I am reading it correctly, if you are diagnosed with PC, then there is a 1 out of 36 chance of dying from it.

david

Post Edited (Purgatory) : 4/18/2012 9:07:53 AM (GMT-6)

If you are diagnosed aged 50 with PCa Gleason 6 and opt for surgery, then you never get a Gleason score that is higher than 6, but you could clealry develop mets aged 65 and die aged 70.

Thus the straightforward answer to the question is yes.

But if the question is: if you don't have the prostate removed when you have a Gleason 6, then does the cancer have to get steadily worse and thus the Gleason score have to get higher and higher over time before the cancer will have spread enough for there to be a risk of it killing you, and as far as I know the answer to that question is yes it does: ie the cancer has to get worse than a Gleason 6 first.
Alf

Of course you can die from gleason 6 pca. You can also drown in a tablespoon of water but the odds are in your favor. Granted this is an opinion and not a science based thesis. We are all going to die. That is a certainty. Momma always said only two things certain in life. Death and taxes. Momma is wise.

compiler said...
That is one arguement for surgery, even with a G-6.  

That would depend largely on what the second, confirmatory biopsy indicated?

No, I meant a second, confirmatory biopsy that one would have before entering Active Surveillance (part of the arguement AGAINST an aggressive, unnecessary treatment for low-risk men).

So what would you folks say about a recurrence of Gleason 6 PCa?

Would / could that gleason 6 become life-threatening?  Without a prostate to reside in, would that gleason 6 progress to a gleason 7 or beyond?  Or with a recurrence, is the gleason score no longer of importance?

HD_Rider,

Being a OC G6 at 42 years old I have tried to find as much information about recurrence in “low risk” PCA as I could since I seem to have a lot of time left to live with this.

So, after scouring the WEB for nearly 4 years I have found only a couple of studies that address the "low risk" recurrence issue. In both studies only a very small number of people had recurrence and none of them went on to develop clinically significant disease during the study period. Ranging from (1-25) years. Approx.  3000+ people.

In fact, everyone that had BCR and attempted salvage RT had subsequently went back to undectable. Eluding to the fact the all the failures were local. So salvage RT seems to give OC G6 people a second chance at cure so to speak.

Even after tracking all the OC G6 people here on HW. I found only one person to fail surgery and that person had salvage SRT and has now been undetectable for 3 years. Everyone else here who was G6 and had BCR either had a positive margin or some other adverse pathological feature.   But they also have not progressed clinically yet either.

I also looked at Yananow.net because you can now narrow down everyone by type of treatment and Gleason score and none of the OC G6 people out of around 208 have had BCR over there. You have to read into each story because some people are recorded as biopsy G6 but then were upgraded after surgery.

So, even BCR for OC G6 does not seem to be an issue in the short term. (15-20) years. Heck I even got a $1,000,000 life insurance policy after I was treated that carries a 20 year term.   So even the insurance companies don’t think you are a big risk for death in the next 20 years from PCa.

But really what I need to know about is 30-40 years.

I agree with the 2nd opinion suggestion by Sleepless.  I had 3 pathologists read my slides and the last one was Epstein at Johns Hopkins.   

Dx @ 42yrsold PSA 2.76 Biopsy Gleason 6
open RP 10/08 Johns Hopkins Post-op pT2 Organ Confined Gleason 6 (tertiary score 0)
<0.03 All PSAs (2/24/2012 last read)

Post Edited (ChrisR) : 4/18/2012 12:54:52 PM (GMT-6)

HD_Rider,

Both guys on here that had G6 with a positive margin are 4 years out from salvage SRT and are still undetecable as far as I can see from their postings. So chin up, buddy.....

questionaboutit,

You are not technically G6.  You are really 3+4=7.  Some might class you as G6 with a Tertiary score of 4, your still actually a G7 no matter how small the amount of grade 4 cells you had.  This puts you in a different prognastic group.

Dx @ 42yrsold PSA 2.76
Gleason 6 (6 out of 50 Cores positive - Small Focus Each)
open RP 10/08 Johns Hopkins
Post-op pT2 Organ Confined Gleason 6 (tertiary score 0)
<0.03 All PSAs (2/24/2012 last read)

Post Edited (ChrisR) : 4/18/2012 1:12:43 PM (GMT-6)

Common misconception is that Gleason 3+3 alone means "low-risk." It does not.

While about half of all prostate biopsies result in Gleason 3+3, only about half or 3/4 of those meet the criteria for "low-risk." Men with low risk PC are encouraged by the NCCN to consider active surveillance after a second, confirmatory biopsy, but they should meet ALL the "low-risk" criteria, not just some of the criteria.

That was true before the 2005 ISUP meeting.  They changed that stating that no matter how small the pattern was, it should be mentioned and the cancer should be treated as though it was the higher of the two patterns.  It was done primarly, I believe, to prevent people with 3+3 and a small amount of pattern 4 or 5 from going on watchful waiting.  If the pathologist doesn't want to inculde it in the final grading then it should at least be mentioned as a tertiary pattern and the patient should be managed as 3+4=7 not 3+3=6.

I believe that Epstein suspected that OC G6 had an extremely good prognosis and wanted to see if he could confirm this by looking at just OC G6 patients to see how the did after treatment.

All I can say is read the following study about it and decide for yourself.

http://prostatecancerinfolink.net/2010/01/06/an-update-on-gleason-grading-system-today/