PROSTATE PROS Episode 4: Six, Not a Bad Score


“There’s rapid progress ongoing in the prostate cancer world and new treatments are being developed all the time.  One of the major advantages of active surveillance is postponing irreversible therapy because down the line a less damaging type of treatment may be invented.”

Roughly 40-50% of men with prostate cancer have Gleason 6.  While Gleason 6 may sound like an intimidating diagnosis, it is actually a type of prostate cancer that does not spread.  Despite this fact, many men still opt for treatment. This may be due to the fear that comes with hearing the word “cancer,” and the tendency to make treatment decisions based on partial information.  Unfortunately for these men, treatment is often worse than the disease. Active surveillance is a safe alternative for monitoring Gleason 6 prostate cancer without the side effects that come with treatment.  

Active surveillance protocol has greatly improved over the last decade.  Sadly, not all doctors are up to date with the latest protocol. Active surveillance used to consist of PSA testing followed by periodic random biopsies.  Random biopsies are uncomfortable and can have side effects such as sepsis and impotence. They can also be inaccurate, missing high grade prostate cancer lurking in corners of the gland.  Random biopsy makes active surveillance an unappealing option for many men.  

Fortunately, in modern active surveillance, the 3-Tesla multiparametic MRI (3T mpMRI) has replaced the random biopsy.  Imaging with 3T mpMRI accurately distinguishes between Gleason 6 and higher grade cancers throughout gland. This non-invasive scan is also free of side effects.  If a higher grade cancer does develop while on active surveillance, a targeted biopsy will be recommended. By following modern active surveillance protocol, any higher grade prostate cancers will be caught early when they are still very susceptible to treatment.  Monitoring with the correct, updated technologies is crucial for active surveillance success. It is important to find a doctor who is familiar with modern active surveillance protocol.  

Modern Active Surveillance Protocol: 

  • PSA testing three to four times a year
  • 3T mpMRI once a year
  • If new lesion appears, existing lesion grows a targeted biopsy is recommended 

Benefits of Active Surveillance: 

While men of any age are eligible for active surveillance, it may be particularly beneficial to men who are still sexually active.  Erectile dysfunction occurs in about 50% of men who have surgery or radiation, active surveillance allows for men to preserve sexual and urinary function.  If men on active surveillance develop a new cancer and end up needing treatment, they will likely benefit from technology that has yet to be invented. 

Enter Amazon giveaway for The Key to Prostate Cancer: NO PURCHASE NECESSARY. See Official Rules

Bill Duke’s Book, Bill Duke: My 40-Year Career, On Screen and Behind the Camera:  

Register for the PCRI Patient Conference: 

Are you eligible for active surveillance? Take the prostate cancer staging quiz:

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The purpose of this podcast is to educate and inform.  The information presented on this podcast and corresponding blog posted on should not be used in place of a physician consult.  Guests on the podcasts present their own opinions and conclusions, these views do not necessarily represent that of Prostate Oncology Specialists.

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