Gleasons 3+3 and 3+4

If you have received a Gleason 3+3 or 3+4 diagnosis, it is imperative that you learn about this diagnosis. Far too often, men will hastily jump into treatment because they hear the word "cancer". All cancers have varying degrees of severity and prostate cancer is no different.

You have been told by your urologist that your biopsy results of Gleason 3+3=6 or 3+4=7 and “you have cancer and must be treated ASAP”.  Stop. Take a deep breath. You have time to research and think. Do your homework. Once you start reading, you will realize that your urologist is lying to you. Ask your urologist the following questions:

  • Has anyone died from Gleason 3 (3+3 and/or 3+4)?
  • Has anyone had his Gleason 3 (3+3 and/or 3+4) "progress" or metastasized into (deadly) Gleason 4 (4+3 or higher)?

These 2 questions can form the foundation for possible treatments or doing Active Surveillance (AS) by monitoring our prostate with PSA tests and annual 3T MRI imaging.

The answer to both of these questions is basically "no". Less than 0.1% WORLDWIDE in studies of 20,000+ patients. If your doctor says otherwise, PLEASE ask for the research data. However, that being said, you should always be doing your own research. There is a lot of information to take in so please read through it – you are worth it.

Pre-2005, urologists were treating ANY Gleason 2s (Ex: G2+3=5) as cancer with radiation or surgery. Then after an International Urological Association vote, they stopped. No more worrying about G2s or treating them. They were right. Could the same shift be happening today with G3s? It will be difficult to find a doctor who agrees with this so be careful about checking the box for “family history” unless your relative died from PCa or you know their Gleason score to be G4 or higher.

Doctors have demonstrated that treating Gleason 3+3=6 and/or Gleason 3+4=7 is over treatment for 99.9% of men because:

  • Essentially NO ONE (< .1%) dies from G3's. (Thus, how can we possibly be cured if it cannot kill us in the first place?)
  • G3's do NOT (< .1%) progress/metastasize into problematic G4's.
  • As the "volume" or size of a G3 SLOWLY grows, it does NOT also metastasize or progress into high grade G4+3.
  • G3's do not leave the prostate and metastasize elsewhere in the body.

Important points to note:

  • It is simply unrealistic to assume that our doctors to be all knowing about all treatments; and/or be unbiased.
  • The only current “gold standard” is the 3T MRI for detection. Any ensuing biopsies showing G3s or G4s should get a 2nd pathology opinion. CAUTION: since not all urologists have access to a 3T MRI machine, they may sadly leave that key point out of your "discussion" as they do not want you to question them or go elsewhere.
  • Currently genomic tests (Prolaris, 4K Score, etc.) are tools that attempt to identify aggressive cancer. Currently, none are a "gold standard" for detection.
  • Get your PTEN and ERG numbers with any biopsy. Another tool that measure the brakes (PTEN) or acceleration (ERG) for the PCa. Per Drs. Pinto and Busch, a G3 with a bad PTEN number while VERY rare, might signify a potential problem.
  • While we all have different DNA for risks and treatments, keep in mind that it is normal for doctors to withhold key information like this that will ultimately impact your judgement and decisions.

For those diagnosed with G7's, know that there is a big difference between 3+4 and 4+3. This can be very confusing and lead to overtreatment. A simple solution is new Gleason 1-5 grading scale as described by the pathologist, Dr. Epstein. The significance is that they now classify Gleason 3+3 is a Grade Group 1 (GG1) or pre-cancerous, and Gleason 3+4 a GG2 or low risk.

Gleason 4+3 is now a GG 3 and an intermediate risk. As Epstein says,

“We hope that this will permit more rational and less emotional decision-making; that men who are assigned a Grade Group 1 out of 5 will know that their cancer has an indolent nature."