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Understanding the Implications of a 3+3 Gleason Score

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When it comes to prostate cancer diagnosis, understanding the Gleason score is of paramount importance. A 3+3 Gleason score is a common term used in prostate cancer pathology reports, and it holds significant implications for patients. In this comprehensive guide, we will delve into the intricacies of the 3+3 Gleason score, exploring what it means, how it is determined, and the implications it carries for patients diagnosed with prostate cancer.

The Basics of Prostate Cancer

Before delving into the specifics of the Gleason score, it's crucial to have a basic understanding of prostate cancer. Prostate cancer is the second most common cancer in men worldwide, with millions of cases diagnosed each year. It originates in the prostate gland, a small, walnut-sized organ responsible for producing seminal fluid.

The diagnosis of prostate cancer typically begins with routine screening, often involving a blood test known as prostate-specific antigen (PSA) test and a digital rectal examination (DRE). If these initial tests suggest the presence of cancer, a prostate biopsy is usually recommended to confirm the diagnosis.

What is the Gleason Score?

The Gleason score, named after pathologist Dr. Donald Gleason, is a crucial component of prostate cancer diagnosis. It helps pathologists and oncologists assess the aggressiveness of the cancer cells in a patient's prostate tissue. The Gleason score is determined by examining prostate biopsy samples under a microscope.

This score is presented as a sum of two numbers, each on a scale of 1 to 5, separated by a plus sign. The first number represents the grade of the most predominant cancer pattern observed, while the second number represents the grade of the second most predominant pattern. These two numbers are added together to calculate the Gleason score, which ranges from 2 to 10.

The Significance of a 3+3 Gleason Score

A 3+3 Gleason score, also known as Gleason 6, is often considered a low-grade prostate cancer. It signifies that the cancer cells in the biopsy sample closely resemble normal prostate tissue and are less aggressive in nature. This is good news for many patients as it suggests that the cancer is slow-growing and less likely to spread beyond the prostate gland.

Active Surveillance and Treatment Options

For patients with a 3+3 Gleason score, the treatment approach may differ from those with higher Gleason scores. One common strategy for low-grade prostate cancer is active surveillance. This approach involves closely monitoring the cancer through regular PSA tests, DREs, and periodic biopsies. It is designed to avoid overtreatment and its potential side effects, such as urinary incontinence and sexual dysfunction.

Active surveillance allows patients and their healthcare teams to keep a watchful eye on the cancer's progression. If there are signs of the cancer becoming more aggressive, treatment options can be revisited.

Treatment Decisions and Shared Decision-Making

For some patients with a 3+3 Gleason score, especially those with other risk factors or preferences, treatment options like surgery or radiation therapy may be considered. However, the decision to pursue treatment should be made after thorough discussions between the patient and their healthcare team.

Shared decision-making is an essential aspect of prostate cancer management. It involves a collaborative approach where the patient's values, preferences, and the potential benefits and risks of treatment are carefully weighed. Ultimately, the choice between active surveillance and treatment should align with the patient's individual circumstances and priorities.

Monitoring and Follow-Up

Whether a patient opts for active surveillance or treatment, regular monitoring and follow-up are essential. This ensures that any changes in the cancer's behavior or progression are promptly detected and addressed.

Active Surveillance Follow-Up

Patients under active surveillance will have a schedule of follow-up tests and appointments with their healthcare team. These may include periodic PSA tests, DREs, and repeat biopsies. The frequency of these tests will be determined by the patient's specific case and risk factors.

Post-Treatment Follow-Up

For patients who undergo treatment, such as surgery or radiation therapy, post-treatment follow-up is equally important. This phase involves monitoring the patient's recovery, assessing treatment effectiveness, and addressing any potential side effects or complications.


A 3+3 Gleason score in prostate cancer diagnosis often signifies a less aggressive form of the disease. It provides patients and their healthcare teams with the opportunity to consider active surveillance as a management option, avoiding unnecessary treatment and its associated risks.

Understanding the implications of a 3+3 Gleason score empowers patients to make informed decisions about their prostate cancer management. Whether choosing active surveillance or treatment, regular monitoring and follow-up are key to ensuring the best possible outcomes in the journey towards managing prostate cancer. It is imperative for patients to engage in open and collaborative discussions with their healthcare providers to determine the most suitable approach for their individual case.

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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