title: Gleason 6 Prostate Cancer: Translating Biology into Population Health.
abstract: OBJECTIVE
  Gleason 6 (3+3) is the most commonly diagnosed prostate cancer among men with prostate specific antigen screening, the most histologically well differentiated and is associated with the most favorable prognosis. Despite its prevalence, considerable debate exists regarding the genetic features, clinical significance, natural history, metastatic potential and optimal management.
  
  
  METHODS
  Members of the Young Urologic Oncologists in the Society of Urologic Oncology cooperated in a comprehensive search of the peer reviewed English medical literature on Gleason 6 prostate cancer, specifically focusing on the history of the Gleason scoring system, histological features, clinical characteristics, practice patterns and outcomes.
  
  
  RESULTS
  The Gleason scoring system was devised in the early 1960s, widely adopted by 1987 and revised in 2005 with a more restrictive definition of Gleason 6 disease. There is near consensus that Gleason 6 meets pathological definitions of cancer, but controversy about whether it meets commonly accepted molecular and genetic criteria of cancer. Multiple clinical series suggest that the metastatic potential of contemporary Gleason 6 disease is negligible but not zero. Population based studies in the U.S. suggest that more than 90% of men newly diagnosed with prostate cancer undergo treatment and are exposed to the risk of morbidity for a cancer unlikely to cause symptoms or decrease life expectancy. Efforts have been proposed to minimize the number of men diagnosed with or treated for Gleason 6 prostate cancer. These include modifications to prostate specific antigen based screening strategies such as targeting high risk populations, decreasing the frequency of screening, recommending screening cessation, incorporating remaining life expectancy estimates, using shared decision making and novel biomarkers, and eliminating prostate specific antigen screening entirely. Large nonrandomized and randomized studies have shown that active surveillance is an effective management strategy for men with Gleason 6 disease. Active surveillance dramatically reduces the number of men undergoing treatment without apparent compromise of cancer related outcomes.
  
  
  CONCLUSIONS
  The definition and clinical relevance of Gleason 6 prostate cancer have changed substantially since its introduction nearly 50 years ago. A high proportion of screen detected cancers are Gleason 6 and the metastatic potential is negligible. Dramatically reducing the diagnosis and treatment of Gleason 6 disease is likely to have a favorable impact on the net benefit of prostate cancer screening.
authors: Scott E
authors: SE
authors: Eggener
authors: Ketan
authors: K
authors: Badani
authors: Daniel A
authors: DA
authors: Barocas
authors: Glen W
authors: GW
authors: Barrisford
authors: Jed-Sian
authors: JS
authors: Cheng
authors: Arnold I
authors: AI
authors: Chin
authors: Anthony
authors: A
authors: Corcoran
authors: Jonathan I
authors: JI
authors: Epstein
authors: Arvin K
authors: AK
authors: George
authors: Gopal N
authors: GN
authors: Gupta
authors: Matthew H
authors: MH
authors: Hayn
authors: Eric C
authors: EC
authors: Kauffman
authors: Brian
authors: B
authors: Lane
authors: Michael A
authors: MA
authors: Liss
authors: Moben
authors: M
authors: Mirza
authors: Todd M
authors: TM
authors: Morgan
authors: Kelvin
authors: K
authors: Moses
authors: Kenneth G
authors: KG
authors: Nepple
authors: Mark A
authors: MA
authors: Preston
authors: Soroush
authors: S
authors: Rais-Bahrami
authors: Matthew J
authors: MJ
authors: Resnick
authors: M Minhaj
authors: MM
authors: Siddiqui
authors: Jonathan
authors: J
authors: Silberstein
authors: Eric A
authors: EA
authors: Singer
authors: Geoffrey A
authors: GA
authors: Sonn
authors: Preston
authors: P
authors: Sprenkle
authors: Kelly L
authors: KL
authors: Stratton
authors: Jennifer
authors: J
authors: Taylor
authors: Jeffrey
authors: J
authors: Tomaszewski
authors: Matt
authors: M
authors: Tollefson
authors: Andrew
authors: A
authors: Vickers
authors: Wesley M
authors: WM
authors: White
authors: William T
authors: WT
authors: Lowrance
mesh_terms: D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D060787:Neoplasm Grading / Q000592:standards; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D018570:Risk Assessment; D057832:Watchful Waiting
keywords: early detection of cancer; neoplasm grading; prostatectomy; prostatic neoplasms; watchful waiting