Eggener Scott E, Badani Ketan, Barocas Daniel A, Barrisford Glen W, Cheng Jed-Sian, Chin Arnold I, Corcoran Anthony, Epstein Jonathan I, George Arvin K, Gupta Gopal N, Hayn Matthew H, Kauffman Eric C, Lane Brian, Liss Michael A, Mirza Moben, Morgan Todd M, Moses Kelvin, Nepple Kenneth G, Preston Mark A, Rais-Bahrami Soroush, Resnick Matthew J, Siddiqui M Minhaj, Silberstein Jonathan, Singer Eric A, Sonn Geoffrey A, Sprenkle Preston, Stratton Kelly L, Taylor Jennifer, Tomaszewski Jeffrey, Tollefson Matt, Vickers Andrew, White Wesley M, Lowrance William T
J Urol. 2015 Sep;194(3):626-34. doi: 10.1016/j.juro.2015.01.126. Epub 2015 Apr 4.
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.
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.
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.
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.
Gleason 6（3+3）是前列腺特异性抗原筛查男性中最常被诊断出的前列腺癌，其组织学分化程度最高，预后最为良好。尽管其发病率很高，但在遗传特征、临床意义、自然病程、转移潜能及最佳治疗管理方面仍存在大量争议。
泌尿肿瘤学会青年泌尿肿瘤学家成员合作，全面检索了经同行评审的关于Gleason 6前列腺癌的英文医学文献，特别关注Gleason评分系统的历史、组织学特征、临床特点、实践模式及结果。
Gleason评分系统于20世纪60年代初设计，到1987年被广泛采用，并于2005年修订，对Gleason 6疾病的定义更为严格。几乎达成共识的是，Gleason 6符合癌症的病理学定义，但对于它是否符合普遍接受的癌症分子和遗传标准存在争议。多个临床系列研究表明，当代Gleason 6疾病的转移潜能可忽略不计，但并非为零。美国基于人群的研究表明，超过90%新诊断出前列腺癌的男性接受了治疗，并面临着患一种不太可能引起症状或缩短预期寿命的癌症而产生发病风险。已有人提出努力减少被诊断为或接受Gleason 6前列腺癌治疗的男性数量。这些措施包括对基于前列腺特异性抗原的筛查策略进行调整，如针对高危人群、减少筛查频率、建议停止筛查、纳入剩余预期寿命估计、采用共同决策和新型生物标志物，以及完全取消前列腺特异性抗原筛查。大型非随机和随机研究表明，主动监测是Gleason 6疾病男性的一种有效治疗管理策略。主动监测显著减少了接受治疗的男性数量，且未明显影响与癌症相关的结果。
自近50年前引入以来，Gleason 6前列腺癌的定义和临床相关性已发生了重大变化。通过筛查检测出的癌症中很大一部分是Gleason 6，其转移潜能可忽略不计。大幅减少Gleason 6疾病的诊断和治疗可能会对前列腺癌筛查的净效益产生有利影响。
