Men with Gleason 5-6 prostate cancer followed for 24 years and treated conservatively have a very low risk of dying from prostate cancer whereas men with Gleason 7-10 are likely to die from prostate cancer
In the pre-PSA era a group of 767 men with localized prostate cancer treated by either just watching it or either immediate or delayed hormones were followed for 24 years. Men who had surgery or radiotherapy were excluded from this study. The average age was 69 and most men were diagnosed in 1980 and 94% of men were followed until death. At the last follow up 61% of men had died from causes other than prostate cancer while 29% had died from prostate cancer. The key messages were:
- Men with low grade Gleason 5-6 disease have a low risk of dying from prostate cancer and are more likely to die of other causes
- Men with Gleason 7, 8-10 prostate cancer are more likely to die from prostate cancer and need aggressive early treatment.
Therefore Gleason 5-6 disease does not need aggressive treatment; however the difficulty is that when a man with Gleason 5-6 has a long life expectancy or is diagnosed young then it is likely that despite these findings they will still be offered treatment.