Prostate Cancer Risk Groups

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Prostate Cancer

Once you have been diagnosed with prostate cancer, you will be told whether you have high risk, intermediate or low risk prostate cancer. This is an important assessment that will inform how what your treatment options are and what your prognosis is likely to be.

Here, we explain how doctors classify prostate cancer risk.

Low risk prostate cancer

Staging of T1c or T2a (prostate cancer that is not possible to feel)
Gleason score of up to 6
PSA of less than 10

If you have low risk prostate cancer, the judgement is that your cancer is likely be slow growing and remain in the prostate gland for many years. If you are in this category, you may be suitable for active monitoring, when you have regular assessments to monitor your disease, rather than immediate treatment, although there is a risk that the cancer may spread. There are many different treatment options that may be suitable for you.

Intermediate risk prostate cancer

Staging T2b/c (prostate cancer can be felt on the digital rectal examination)
Gleason 7
PSA of more than 20

If you have any one of the above, you have intermediate risk prostate cancer. Generally, if you are in this category, you will be advised to have treatment without delay. However, for the intermediate risk group, there is a choice of treatment approaches with good outcomes (although not as favourable as for the low risk group). There is wide variation across this group and discussions with your doctor about your individual situation will form the basis of your decision. Do seek second opinions if you wish.

High risk prostate cancer

T3 or T4 (cancer that is growing outside the prostate)
Gleason 8, 9 or 10
PSA of more than 20

If you have any two of the above, you have high risk prostate cancer. This was traditionally referred to as locally advanced prostate cancer. Men with high risk prostate cancer can still have treatment with curative intent. For men with high risk prostate cancer, an approach based on chemotherapy together with hormone treatment and radiotherapy has been shown to achieve good results which are similar to surgery. Surgery is sometimes an option for men with high risk prostate cancer and if used, a specialist approach is required, called extended lymph node dissection.