Very Low risk vs Low risk vs Intermediate risk vs High risk prostate cancers

After a prostate cancer diagnosis, doctors classify the cancer into risk groups to guide treatment decisions. These categories are based on factors such as the Gleason Grade Group, PSA level, and tumor stage.

Very Low-Risk Prostate Cancer

·         Grade Group 1 (Gleason Score 6)

·         PSA <10 ng/mL

·         Clinical stage T1

·         Cancer involves fewer than 3 biopsy cores, with <50% cancer in any core

·         PSA density <0.15 ng/mL/cm³

Typically indolent. Active surveillance is strongly recommended and curative treatment is often unnecessary unless disease progresses.

Low-Risk Prostate Cancer

·         Grade Group 1 (Gleason Score 6)

·         PSA <10 ng/mL

·         Clinical stage T1–T2

Usually slow-growing. Active surveillance is the preferred option, though treatment may be considered based on patient preference or life expectancy.

Intermediate-Risk Prostate Cancer

·         Grade Group 2–3 (Gleason Score 7)

·         PSA 10–20 ng/mL

·         Or clinical stage T2

Further divided into:

·         Favorable: Gleason 3+4, lower volume, fewer risk factors

·         Unfavorable: Gleason 4+3, multiple intermediate-risk features

Treatment often includes surgery, radiation, and/or short-term hormone therapy.

High-Risk Prostate Cancer

·         Grade Group 4–5 (Gleason Score 8–10)

·         PSA >20 ng/mL

·         Or clinical stage T3 or higher

More likely to spread and requires multimodal treatment, including surgery, radiation, and long-term hormone therapy. Clinical trials may also be considered.

More likely to spread or come back after treatment.
Often requires multi-modal treatment, such as surgery plus radiation or hormone therapy.