Gleason 6 prostate cancer is the most commonly diagnosed cancer amongst men who undergo prostate-specific antigen screening. It is associated with the most favourable prognosis and is the histologically most well differentiated cancer. Despite its prevalence there are still many questions regarding its management and label of ‘cancer’. Following Gleason’s initial grading system, in 2005 the ISUP Consensus Conference reclassified many features from the original system to pattern 4 or 5. Approximately 34% of cases of Gleason 6 prostate cancer in the pre-2005 system were upgraded to Gleason 7 or higher. Despite its label of ‘cancer’, in a review of 14,000 embedded radical prostatectomy specimens there were no lymph node metastases in men with Gleason 6 disease. However, Gleason 6 disease on biopsy may be a surrogate for diseases in other regions of the prostate. Approximately 22% of men diagnosed with Gleason 6 disease have a higher grade or stage present on prostatectomy. Despite the low rates of Gleason 6 disease-associated morbidity and mortality treatment rates range from 55% to 96%. Given findings of contemporary literature there needs to be further discussion regarding the utility of treating Gleason 6 disease versus surveillance.