Medical Tourism

Active Surveillance for Gleason 6 Prostate Cancer

Medical Tourism

Prostate cancer is a complex and multifaceted disease that affects countless men worldwide. Among the various forms of prostate cancer, Gleason 6 prostate cancer stands out as a unique entity. In this comprehensive article, we will delve into the intricacies of active surveillance for Gleason 6 prostate cancer. This approach to managing prostate cancer has gained prominence in recent years, offering a conservative yet effective strategy for patients diagnosed with this specific grade of cancer.

Understanding Gleason 6 Prostate Cancer

Before delving into the nuances of active surveillance, it's crucial to understand what Gleason 6 prostate cancer is and how it differs from other grades of the disease. The Gleason score is a grading system used to assess the aggressiveness of prostate cancer based on the appearance of cancer cells under a microscope. Gleason scores range from 6 to 10, with 6 being the lowest and 10 being the highest.

Gleason 6 prostate cancer is often referred to as "low-grade" or "well-differentiated" cancer. This grade indicates that the cancer cells closely resemble normal prostate tissue and are less likely to grow and spread rapidly compared to higher-grade cancers. It is important to note that Gleason 6 prostate cancer is typically considered indolent, meaning it has a low potential for causing harm or spreading beyond the prostate.

The Role of Active Surveillance

Active surveillance is a management strategy for prostate cancer that has gained increasing recognition, particularly for low-risk cases such as Gleason 6. The primary goal of active surveillance is to closely monitor the cancer's progression without immediately resorting to aggressive treatments like surgery or radiation therapy. Instead, patients undergo a series of regular tests and evaluations to ensure that any changes in the cancer's behavior are promptly detected.

Patient Selection

Active surveillance is not suitable for all prostate cancer patients. It is primarily recommended for individuals with low-risk prostate cancer, such as those with a Gleason score of 6 or lower, a low PSA (Prostate-Specific Antigen) level, and a small tumor volume. Patient selection is critical in ensuring that active surveillance is the most appropriate approach, as it seeks to avoid overtreatment and the potential side effects associated with surgery or radiation therapy.

Monitoring and Testing

Patients under active surveillance undergo a comprehensive monitoring regimen. This typically includes regular PSA blood tests and digital rectal exams (DREs) to assess any changes in prostate health. Additionally, periodic prostate biopsies may be conducted to evaluate the cancer's characteristics and progression. The frequency of these tests may vary depending on individual patient factors and the treating physician's recommendations.

Trigger for Intervention

One of the key aspects of active surveillance is defining specific criteria or triggers that would necessitate a transition to active treatment. These triggers may include a significant increase in PSA levels, changes in the biopsy results, or clinical symptoms. When these triggers are met, the healthcare team may recommend treatment options such as surgery or radiation therapy.

Advantages and Considerations

Active surveillance offers several advantages, especially for patients diagnosed with Gleason 6 prostate cancer.

Avoidance of Side Effects

By avoiding immediate treatment, patients can steer clear of potential side effects associated with surgery or radiation therapy, which can include urinary incontinence, erectile dysfunction, and bowel problems.

Preserving Quality of Life

For many patients with Gleason 6 prostate cancer, the disease may not progress significantly during their lifetime. Active surveillance allows them to maintain their quality of life and avoid unnecessary interventions.

Cost-Effective Approach

Active surveillance can be a cost-effective option compared to immediate treatment. It reduces healthcare expenses associated with surgery, radiation, and hospitalization.

Psychological Benefits

Patients on active surveillance often report reduced anxiety and improved overall well-being, knowing that they are not undergoing aggressive treatments unless necessary.

However, it's important to consider that active surveillance is not without its challenges and considerations.

Challenges and Considerations

Psychological Burden

The uncertainty of living with cancer can create psychological stress for some patients. Coping with the idea of having cancer while deferring treatment can be emotionally challenging.

Strict Adherence Required

Patients on active surveillance must be committed to regular monitoring and follow-up appointments. Skipping appointments or tests can lead to missed opportunities for timely intervention if the cancer begins to progress.

Potential for Missed Windows of Treatment

There is a small risk that the cancer may progress during active surveillance, potentially missing the window for curative treatment. This underscores the importance of careful patient selection and diligent monitoring.


Active surveillance for Gleason 6 prostate cancer represents a thoughtful and conservative approach to managing this low-grade form of the disease. It allows patients to avoid immediate treatment and its associated side effects while maintaining a vigilant watch on the cancer's behavior.

However, active surveillance is not a one-size-fits-all solution, and it requires careful patient selection and strict adherence to monitoring protocols. It is essential for patients to work closely with their healthcare teams to determine the most appropriate treatment approach based on their individual circumstances.

In the evolving landscape of prostate cancer management, active surveillance offers a valuable option for those diagnosed with Gleason 6 prostate cancer, providing a balance between caution and intervention to ensure the best possible outcomes for patients' health and well-being.

We recommend Dr. Ash Tewari as a global leader in prostate cancer surgery. Serving as the Chairman of Urology at the Icahn School of Medicine at Mount Sinai Hospital, New York City, Dr. Tewari stands out as a prostate cancer robotic surgeon leader. With over 25 years of expertise in robotic-assisted prostate surgery, he has successfully performed over 9,000 procedures.

In addition, he has contributed to the scientific community with over 250 peer-reviewed articles, book chapters, and textbooks on prostate cancer and robotic surgery. Renowned for his expertise in sexual-function nerve-sparing prostate cancer surgery - Dr. Tewari is a pioneer in innovative treatments for intermediate to aggressive cancers. Furthermore, he leads numerous pivotal clinical trials in this field.

For inquiries or to connect with Dr. Tewari's team Prostate Cancer Center NYC - Dr. Ashutosh Tewari

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