What Does a Gleason Score of 6 Mean?

This page is for men told their prostate biopsy shows a Gleason score of 6. It explains what the score means, using NCI's descriptions, and why monitoring is a recognized option.

A Gleason score is built from two numbers. NCI explains that a pathologist (a doctor who studies tissue) finds the two main cell patterns in the tissue samples, grades each from 3 to 5, and adds them. Grade 3 looks the most like normal prostate tissue. Grade 5 looks the most abnormal.

A score of 6 is therefore 3+3. Both the most common pattern and the next most common pattern were the least abnormal grade the scale uses.

NCI states the Gleason score can range from 6 to 10, and describes a score of 6 as a low-grade cancer. It is the bottom of the range in ordinary use.

• 6 — low-grade cancer
• 7 — medium-grade cancer
• 8, 9 or 10 — high-grade cancer

NCI also states that the higher the Gleason score, the more likely the cancer will grow and spread quickly. A 6 is at the opposite end of that statement from a 9 or 10.

NCI maps the Gleason score onto a Grade Group, and states that Grade Group 1 is a Gleason score of 6 or less.

Your report may show the Grade Group, the Gleason score, or both. They are describing the same finding in two notations.

For staging, NCI states that the Grade Group and PSA level are used together, so the Grade Group on its own is not the stage.

This page will not tell you that a 6 is nothing to think about. That is not what the source says, and it would not be honest.

What NCI says is that grade describes how abnormal the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread. Low grade is a statement about appearance and expected behavior. It is not a statement that no cancer is present, and it is not a prediction about you specifically.

NCI lists what actually drives prognosis (the likely outcome) and options:

• The stage of the cancer. This includes PSA level, Gleason score, Grade Group, how much of the prostate is affected, and whether the cancer has spread.
• The patient's age.
• Whether the cancer is new or recurrent (has come back).

Treatment options may also depend on other health problems, expected side effects, past treatment, and the wishes of the patient.

People sometimes hear "we will watch it" as a sign of being dismissed. NCI lists watchful waiting and active surveillance among the types of treatment used for prostate cancer, alongside surgery, radiation therapy, hormone therapy and others.

NCI describes the two differently:

• Watchful waiting — closely monitoring a patient's condition without giving any treatment until signs or symptoms appear or change.
• Active surveillance — closely following a patient's condition without giving any treatment unless there are changes in test results. It uses exams and tests including digital rectal exam (a gloved finger exam of the prostate), PSA test, transrectal ultrasound and transrectal needle biopsy to check whether the cancer is growing. NCI states that when the cancer begins to grow, treatment is given to cure the cancer.

NCI notes that other terms used for this include observation, watch and wait, and expectant management.

If monitoring is proposed, it is reasonable to ask which of these is meant, what the schedule is, and what result would change the plan.

• Does my report state Grade Group 1, and is my score written as 3+3?
• What was my PSA level at diagnosis?
• How many cores were taken, how many had cancer, and what percentage of each core?
• Has a second pathologist reviewed the slides?
• If monitoring is suggested, is it watchful waiting or active surveillance, and what tests and intervals does it involve?
• What specific change would move us from monitoring to treatment?

See What Does a Gleason Score Mean?, What Does a Gleason Score of 7 Mean?, and Getting a Second Opinion.

• https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq