Prostate Cancer Risk Groups

What Is a Prostate Cancer Risk Group?

Before we can determine the best course of treatment for your prostate cancer, it’s important that we work to identify what your risk group is. You may be asking yourself, “what is a risk group?” This is actually very important information to know.

Basically, your risk group is how we categorize the severity of your cancer so that we can determine how aggressive your treatment should be. Prostate cancer risk groups are categorized by low, moderate, and high.

  • Low Risk: Cancer is located only in the prostate, and the PSA is <10 and grade group 1 (Gleason 6). This group also has a subcategory of “slow-growing” or “very low risk.”

  • Moderate Risk: Cancer is located only in the prostate; the PSA is between 10 and 20, or grade group 2 or 3 (Gleason 7). This group can be further categorized by “favorable” or “unfavorable” based on other factors about your particular cancer.

  • High Risk: Cancer has spread to outside of the prostate, the PSA >20, or grade group 4 or 5 (Gleason 8 to 10).

These risk categories are used in conjunction with other information such as lymph node involvement and other factors to help determine the best treatment path.

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Frequently Asked Questions About Prostate Cancer

Are there other factors to look at besides Gleason Score, PSA, and Stage?

Yes. We also look at the number of needles with cancer, the amount of cancer in the biopsy, and perineural invasion. Each piece of information is like a piece to a puzzle. All of these factors will help determine the severity of your cancer so we can make the best plan moving forward.

My Gleason score says I have faster-growing prostate cancer than most men, but my PSA is below average, and I have the earliest stage you can have – T1c. How do you put this all together?

Based upon a man’s Gleason score, PSA, and stage, we classify men into prostate cancer risk groups: low, moderate, and high – which indicates the increased risk of aggressive, incurable cancer. The three risk groups are listed in the table here, which also shows the percent of men in the various risk groups. Based upon a Gleason score of 4+3=7, you would be in the moderate-risk group. On the other hand, if you had a Gleason score of 3+3=6, you would be in the low-risk group. There also is a subset of the Low-risk group called Very Low. These risk groups combine Gleason, PSA, and stage.



I was told I was in a moderate-risk group, with a low PSA of 4.4 and stage T1c. Why is that?

To be in the moderate-risk group, you only need one factor. It was Gleason 7 (4+3). If you had Gleason 3+3=6 but PSA 14.3, you would also be in the moderate group. On the other hand, if you had Gleason 4+4=8, you would be in the high group.

Why did I get prostate cancer?

No one really knows why someone develops cancer while someone else does not. We can only assume that something in your prostate caused one of your normal prostate cells to change into a cancer cell. Normal cells in the body (prostate, liver, lung, etc.) have a balanced growth: when a new cell is made, an older one dies off, so the total cell number stays even. In contrast, cancer cells have uncontrolled growth. So, you have one cancer cell becoming two cancer cells, and those two cancer cells multiply to four cancer cells, then eight, and so forth.

Cancer Cell Growth - Beginning of Prostate Cancer



When did my prostate cancer start?

We don’t know. It was probably several years ago when your first cell transformed into malignancy. It can be frustrating for patients who felt healthy and then suddenly received a cancer diagnosis. Unfortunately, prostate cancer rarely shows any symptoms until the cancer has developed significantly. It’s not unusual for us to work with patients with more advanced prostate cancer simply because they had no idea that there was a problem.

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