Gleason 6 that Metastasized?

If your question is "can a Gleason 3+3 morph into a higher grade?", the conclusions that I have read on a number of recent threads is "yes, but it's extremely rare".

The analyses of the Sunnybrook and Johns Hopkins AS groups found maybe 2 cases where they believe that a G6 morphed into a higher grade, out of almost 3,000 cases studied over many years.

Whether or not Gleason 6 cancer ever metastasizes depends on where you stand in time to look at it and, thus, which way you are looking -- ahead or back.

What seems to be true is that the Gleason Type 3 cells -- as in Gleason 6(3+3) -- are incapable of establishing distant metastases. They don't cast off into the blood stream or the lymphatic system and take root somewhere else. But...

The presence in the prostate of a Gleason 6 tumor doesn't guarantee that another higher grade lesion can't occur somewhere else in the gland. This is somewhat rare but it happens. What is much rarer -- so rare that there are doctors who aren't convinced it ever happens -- is when the same lesion that was Gleason 6 morphs into a higher grade tumor (one that can metastasize.)

So, if you stand at the point of diagnosis, looking forward in time, and ask the question "Does Gleason 6 ever metastasize?" The answer is that it is rare but it can and does happen by one of three pathways: 1) the Gleason 6 diagnosis is in error and there are higher grade lesions that were missed in the biopsy; 2) After diagnosis a new tumor may form with a higher grade; and 3) the Gleason 6 lesion might undergo a further change and morph into a higher grade.

On the other hand, if you stand at the point where metastases are demonstrated and look backward in time the answer, in simple terms, is "No, it doesn't happen." Researchers have looked at men who developed metastases after having their prostates removed looking for any who had been Gleason 6 on their post-op pathology report. They then went back to the slides from those reports and had new reports produced by expert pathologists. In all but a couple of cases the new report showed a revised Gleason score higher than 6. Those few remaining cases of Gleason 6 metastasis were so few that they are more easily explained as lab errors or some other fluke.

Unfortunately, the point of diagnosis, where we know the least, is where most of the decisions have to be made.

J&D: You are stuck in the middle of my time-continuum. You know more about things than you did at diagnosis but, sadly, you never get to know for sure until the fat lady sings. Still, being Gleason 6 at the margin is pretty hopeful and that <0.006g uPSA is good to see.

I don't see anything in that link that said it was Gleason 6 - Can you point it out to me? It seems odd that the pathology report did not include the Gleason score. Perhaps protocols were different in Toledo in 2007.

Thanks, I see that now - I agree with PDA that it's all about timing. While metastases were not detected immediately, over many years, some GS 6 cancer left behind was ably to undergo that transition. From long-term AS studies, we've learned that in about half the cases, the cancer does progress to higher grade (and that is true even with very frequent biopsies, as in the JH protocol, so it's unlikely that it's just that the higher grade cancers were missed). There is some evidence that the same progenitor cells can give rise to both Gleason pattern 3 and Gleason pattern 5. The best we can do is monitor for uPSA increases.

Trying to guess what is going on inside your body at the cellular level is an exercise in futility..

Perfectly normal, healthy, prostate cells can mutate into abnormal G-6 cancer cells.....So it stands to reason that indolent G-6 cancer cells can mutate into G-4 or G-5 not so indolent cells....I mean, perfectly normal cells can do that so why can't G-6 cancer cells do that??

Since cancer cells multiply at a much faster rate than normal cells, it would seem there is a greater chance of G-6 cells morphing into something more difficult to deal with than the original problem..