Thirteen prostate biopsy cores were taken and five contained prostatic adenocarcinoma. All were Gleason 3+3=6, Grade Group 1. Can this cancer be cured or eliminated completely?
Quick Answer: Can Gleason 3+3=6 Prostate Cancer Be Cured?
Yes. Localized Gleason 3+3=6 (Grade Group 1) prostate cancer can be treated with curative therapies such as surgery or radiation. However, many men with truly low-risk Grade Group 1 cancer do not need immediate treatment because active surveillance is usually the preferred first approach.
- Gleason 3+3=6 = ISUP Grade Group 1, the lowest grade routinely diagnosed as prostate cancer.
- If PSA is below 10 ng/mL, clinical stage is T1–T2 and no higher-risk findings are present, this is usually classified as low-risk prostate cancer.
- For suitable men with more than about 10 years of life expectancy, current European guidelines recommend active surveillance as standard care.
- Having 5 of 13 biopsy cores positive is important information because it indicates greater biopsy-detected cancer volume than one or two tiny positive cores, but it does not automatically rule out active surveillance.
- PSA, PSA density, MRI, clinical stage, percentage of each core involved and biopsy technique should all be reviewed before deciding whether surveillance or treatment is best.
- Hormone therapy alone is not standard treatment for localized low-risk Grade Group 1 disease.
What Does Gleason 3+3=6 Mean?
The Gleason system describes how prostate-cancer tissue looks under the microscope.
In Gleason 3+3=6, the biopsy shows only Gleason pattern 3 in the cancer that was sampled.
Under the modern ISUP system, this corresponds to:
Grade Group 1.
This is the lowest Grade Group currently used for prostate adenocarcinoma.
| Grade Group | Gleason Score | General Interpretation |
|---|---|---|
| 1 | 3+3=6 | Lowest routinely diagnosed prostate-cancer grade |
| 2 | 3+4=7 | Mainly pattern 3 with some pattern 4 |
| 3 | 4+3=7 | Mainly pattern 4; clinically more concerning |
| 4 | Gleason 8 | Higher-grade cancer |
| 5 | Gleason 9–10 | Highest Grade Group |
This is why Grade Group 1 should not be interpreted in the same way as the Gleason 4+3=7 Grade Group 3 cancer we discuss elsewhere on this site.
Does Grade Group 1 Automatically Mean Low-Risk Prostate Cancer?
Not by itself.
Grade Group is only one part of prostate-cancer risk assessment.
Current EAU classification generally defines localized low-risk prostate cancer as:
- ISUP Grade Group 1;
- PSA below 10 ng/mL;
- and clinical stage T1–T2.
Therefore, I would want to know JD’s PSA level , prostate volume, PSA density, MRI findings and clinical stage before describing the cancer simply as low risk.
What Does 5 Positive Cores Out of 13 Mean?
This is clinically relevant information.
Five positive biopsy cores mean that cancer was detected in five of the thirteen tissue samples examined.
That suggests a greater amount of biopsy-detected disease than, for example, one very small positive core.
However, the number 5 of 13 should not be interpreted in isolation.
The urologist also needs to know:
- how much cancer is present within each positive core;
- the maximum cancer length in each core;
- whether the positive cores came from one MRI lesion or several areas;
- whether the biopsy was systematic, MRI-targeted or combined;
- PSA density;
- and what the MRI shows.
Five Positive Cores Do Not Automatically Mean You Need Surgery
Older surveillance protocols often used strict limits on the number of positive biopsy cores.
Modern MRI-targeted biopsy has made this more complicated. Current EAU guidance notes that the number of positive cores is not always a reliable measure of cancer volume when multiple targeted samples come from the same MRI-visible lesion.
Can Gleason 3+3=6 Cancer Be Eliminated Completely?
Potentially, yes.
When Grade Group 1 cancer is truly confined to the prostate, treatments such as radical prostatectomy or definitive radiation therapy can be used with curative intent.
But this creates an unusual situation in low-risk prostate cancer:
The fact that a cancer can be treated does not mean immediate treatment is the best choice.
Many Grade Group 1 cancers grow so slowly that they may never cause symptoms or threaten the patient’s life.
Immediate treatment can therefore expose a man to:
- urinary incontinence;
- erectile dysfunction;
- ejaculatory changes;
- bowel or urinary radiation effects;
- and other treatment complications;
without necessarily improving survival compared with carefully managed surveillance.
The Goal of Active Surveillance Is Not to Ignore the Cancer
The goal is to avoid unnecessary treatment while the disease remains low risk, but still identify biological progression early enough to use curative treatment if it becomes necessary.
Is Active Surveillance Appropriate for Grade Group 1?
For suitable men with confirmed low-risk disease and an estimated life expectancy above about 10 years, active surveillance is the standard first management option in current EAU guidance.
Long-term outcomes from well-run active-surveillance programs are excellent.
EAU summarizes published active-surveillance cohorts as having approximately 98.1–100% prostate-cancer-specific survival at 10 years.
However, surveillance does not mean simply checking a PSA once in a while.
Active Surveillance May Include
- PSA testing, typically at least every six months;
- clinical review;
- digital rectal examination according to the surveillance protocol;
- prostate MRI;
- and repeat biopsy when indicated by the protocol and previous MRI/ biopsy findings.
If PSA begins rising more rapidly, MRI changes or other findings become concerning, a repeat biopsy is generally used to determine whether the cancer has actually changed grade.
Active Surveillance Is Not the Same as Watchful Waiting
| Active Surveillance | Watchful Waiting | |
|---|---|---|
| Main goal | Preserve the opportunity for cure if cancer progresses | Control symptoms if cancer later causes problems |
| Typical patient | Fit patient with low-risk cancer and longer life expectancy | Often older/frail patient or life expectancy below ~10 years |
| Monitoring | Structured PSA, MRI and/or repeat biopsy | Less intensive and individualized |
| Intent | Curative treatment remains available if needed | Primarily symptom-directed rather than curative |
What Information Do We Still Need Before Choosing a Plan?
From the question we know:
- 13 biopsy cores were taken;
- 5 were positive;
- all reported cancer was Gleason 3+3=6 / Grade Group 1.
That is useful, but it is not enough for an individualized treatment recommendation.
I would also want:
- PSA
- Prostate volume
- PSA density — PSA divided by prostate volume
- Multiparametric MRI findings, including PI-RADS category and lesion size
- Clinical stage
- Percentage or length of cancer in each positive core
- Whether biopsy samples were systematic, targeted or both
- Any relevant adverse pathological features
- Age, general health and estimated life expectancy
- Important family history or inherited prostate-cancer risk
Our prostate biopsy results guide explains how Grade Group and other pathology findings are interpreted.
Why Is PSA Density Important?
PSA density compares the PSA level with prostate volume.
A man with a large benign prostate can have a higher PSA simply because there is more prostate tissue producing PSA.
Conversely, a relatively high PSA coming from a small prostate may be more concerning.
EAU identifies PSA density as an important predictor of cancer reclassification during active surveillance.
A stable MRI combined with a PSA density below approximately 0.15 ng/mL/cc is associated with a particularly low risk of progression in appropriately selected low-risk patients.
This is one reason an isolated PSA number does not tell the whole story.
Why Does MRI Matter With Gleason 6?
A biopsy samples only selected areas of the prostate.
One concern after a Grade Group 1 biopsy is whether a higher-grade cancer could have been missed elsewhere in the gland.
Modern multiparametric MRI helps identify suspicious areas that may need targeted sampling.
If the original biopsy was performed without an appropriate pre-biopsy MRI, current EAU surveillance guidance recommends MRI before a confirmatory biopsy.
Biopsy Grade Is Based on the Tissue That Was Sampled
Grade Group 1 on biopsy is reassuring, but a biopsy cannot examine every cell in the prostate. MRI and appropriate repeat sampling help reduce the chance that a more significant area was missed.
What About Radical Prostatectomy?
Radical prostatectomy removes the prostate and seminal vesicles and can cure localized prostate cancer.
However, for confirmed low-risk Grade Group 1 disease, immediate surgery is often considered overtreatment.
Potential effects include:
- urinary leakage or incontinence;
- erectile dysfunction;
- loss of ejaculation;
- infertility;
- and surgical complications.
Therefore, the question is not simply:
“Can surgery remove the cancer?”
It can.
The more important question in Grade Group 1 is:
“Will treating this cancer now improve my outcome enough to justify the treatment risks?”
What About Radiation Therapy?
Definitive radiation can also treat localized prostate cancer with curative intent.
Possible approaches include external-beam radiation and, for selected patients, brachytherapy.
Potential adverse effects include:
- urinary irritation;
- bowel irritation;
- fatigue;
- and erectile dysfunction that may develop over time.
As with surgery, current EAU guidance regards whole-gland treatment as highly likely to represent overtreatment when a patient’s disease is truly low risk.
Is Hormone Therapy Used for Gleason 3+3=6?
Not routinely for localized low-risk disease.
This is an important correction to the older answer.
Androgen-deprivation therapy (ADT) lowers testosterone signaling and is an important treatment in several higher-risk, recurrent and metastatic prostate-cancer settings.
But current EAU guidance does not recommend ADT monotherapy as treatment for asymptomatic localized low-risk prostate cancer.
ADT has meaningful adverse effects, including:
- hot flushes;
- loss of libido;
- erectile dysfunction;
- bone loss;
- loss of muscle mass;
- weight and metabolic changes;
- and other quality-of-life effects.
What Is the Prognosis for Grade Group 1 Prostate Cancer?
When the complete clinical picture confirms localized low-risk Grade Group 1 cancer, prognosis is generally excellent.
EAU reports prostate-cancer-specific survival of approximately 98.1–100% at 10 years in published active-surveillance cohorts.
NCI likewise describes Gleason 6 as low-grade prostate cancer and notes that prognosis depends on stage, PSA, amount of cancer, age and other individual clinical factors. :contentReference[oaicite:2]{index=2}
However, “excellent prognosis” does not mean the diagnosis should simply be forgotten.
Some biopsy Grade Group 1 cancers are later found to contain higher-grade disease because:
- a more significant area was missed by the original biopsy;
- or the disease becomes reclassified during surveillance.
That is why structured surveillance matters.
How Do You Know Whether Cancer Has Been “Eliminated”?
The word eliminated needs careful interpretation.
After radical prostatectomy, PSA should fall to an undetectable or very low level because the prostate has been removed.
After radiation, the prostate remains in place, so PSA usually falls gradually rather than becoming immediately undetectable.
Even after apparently successful curative treatment, doctors continue long-term PSA monitoring because microscopic recurrence is possible.
Therefore, physicians generally speak of:
- curative-intent treatment;
- no evidence of disease;
- or biochemical recurrence;
rather than guaranteeing that every cancer cell has permanently been eliminated.
Questions JD Should Ask His Urologist
With five of thirteen cores positive, I would ask for the complete risk assessment rather than deciding from the Gleason number alone.
- What is my current PSA?
- What is my prostate volume and PSA density?
- What is my exact clinical stage?
- Did I have a high-quality multiparametric MRI?
- What PI-RADS lesions, if any, were present?
- What percentage or length of each of my five positive cores contains cancer?
- Were several positive cores taken from the same MRI lesion?
- Was my biopsy systematic, targeted or both?
- Does the pathology show any feature that makes active surveillance less appropriate?
- Am I a good candidate for active surveillance under your current protocol?
- If I choose surveillance, exactly what PSA, MRI and repeat-biopsy schedule will you use?
Understanding these findings is part of the broader prostate testing and cancer-risk assessment process.
Dr. Albana’s Answer
Hello JD,
Your biopsy result of Gleason 3+3=6, Grade Group 1 is reassuring compared with higher-grade prostate cancers.
Yes, localized Grade Group 1 cancer can be treated with curative approaches such as surgery or radiation.
However, I would not interpret “curable” as meaning that you necessarily need immediate treatment.
When PSA, MRI and clinical stage confirm that Grade Group 1 disease is genuinely low risk, current guidelines generally favor active surveillance. The purpose is to avoid exposing a man to urinary, sexual or bowel treatment side effects for a cancer that may never threaten his health.
Your five positive cores are important. They tell me that this is not simply one tiny focus discovered in one core. But the number of cores alone is no longer enough to decide whether surveillance is safe, particularly when MRI-targeted biopsy has been used.
I would want your PSA, prostate volume and PSA density, MRI report, clinical stage and the amount of cancer within each positive core.
If you did not have MRI before the biopsy, discuss whether MRI and appropriate confirmatory assessment are needed before committing to a long-term surveillance strategy.
I would also remove hormone therapy from the list of routine treatment options for this situation. ADT alone is not standard treatment for an otherwise asymptomatic man with localized low-risk Grade Group 1 cancer.
So my answer is: yes, the cancer can potentially be treated curatively—but if the full assessment confirms low-risk disease, the safer first choice may be to monitor it carefully rather than trying to eliminate it immediately.
— Dr. Albana Greca, MD, MMedSc, Family Physician / General Practitioner
Most Asked Questions About Gleason 3+3=6 Prostate Cancer
Is Gleason 3+3=6 really prostate cancer?
Yes. Under current pathological classification it is prostate adenocarcinoma and corresponds to ISUP Grade Group 1. It is the lowest Grade Group routinely diagnosed and generally behaves much less aggressively than higher-grade prostate cancers.
Can Grade Group 1 prostate cancer be cured?
Yes. Localized Grade Group 1 disease can be treated with curative-intent surgery or radiation. However, immediate treatment is often unnecessary when the cancer meets low-risk active-surveillance criteria.
Does Gleason 6 always need treatment?
No. Active surveillance is the standard management approach for many suitable men with confirmed low-risk Grade Group 1 disease and a life expectancy greater than about 10 years.
Is five positive biopsy cores a lot?
It represents more biopsy-detected disease than one or two small positive cores and can increase concern about reclassification. However, the significance depends on how the biopsy was performed, how much cancer is in each core, MRI findings, PSA density and other risk factors.
Can I still have active surveillance with 5 of 13 positive cores?
Possibly. The answer cannot be based on core count alone. Modern MRI-targeted biopsy may produce several positive samples from one lesion, and current surveillance selection considers PSA density, MRI, cancer extent and other clinical factors.
Can Gleason 6 turn into a higher-grade cancer?
Some men are later found to have higher-grade disease. This can happen because the initial biopsy missed a higher-grade focus or because the disease is reclassified during follow-up. Structured active surveillance is designed to detect this.
Is surgery better than active surveillance for Gleason 6?
Not routinely. For appropriately selected low-risk disease, immediate whole-gland treatment is highly likely to be overtreatment. Surveillance avoids treatment side effects while retaining the option for curative therapy if the cancer becomes more significant.
Is hormone therapy used for Grade Group 1?
ADT monotherapy is not standard treatment for asymptomatic localized low-risk Grade Group 1 prostate cancer.
What is the prognosis for Gleason 3+3=6?
When the complete clinical assessment confirms localized low-risk disease, the prognosis is excellent. Published active-surveillance cohorts cited by EAU report approximately 98.1–100% prostate-cancer- specific survival at 10 years.
Related Prostate Cancer & Biopsy Guides
Medical References
-
European Association of Urology.
EAU Guidelines on Prostate Cancer — Treatment.
2026.
EAU Prostate Cancer Treatment Guideline -
European Association of Urology.
EAU Guidelines on Prostate Cancer — Classification and Staging.
2026.
EAU Classification & Staging -
European Association of Urology.
EAU Guidelines on Prostate Cancer — Diagnostic Evaluation.
2026.
EAU Diagnostic Evaluation -
National Cancer Institute.
Prostate Cancer Treatment (PDQ®).
National Cancer Institute -
National Cancer Institute.
Active Surveillance for Prostate Cancer.
National Cancer Institute
Medical information notice: Gleason score alone does not determine the appropriate prostate-cancer treatment. PSA, PSA density, clinical stage, MRI findings, biopsy extent, pathology, age, health and individual preferences should be reviewed with the treating urologist before choosing active surveillance, surgery or radiation.
Written & medically reviewed by Dr. Albana Greca, MD, MMedSc • Family Physician / General Practitioner • Last medically reviewed: August 2026