Prostate Cancer Risk Groups
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In localized prostate cancer, cases can be categorized according to their relative risk of progression. This helps support clinicians in determining the best treatment options for you, by balancing the aggressiveness of treatment according to your risk for severe disease.
Prostate cancer risk group classification
Risk grouping is based on your clinical T stage, prostate-specific antigen (PSA) levels, grade group (based on your Gleason score), and estimated tumor size (determined by your biopsy). These factors in particular are associated with increased risk of biochemical recurrence and a higher risk of death due to prostate cancer. As time goes by, these categorizations will be regularly updated according to new clinical data.
Below, you can find the risk grouping guidelines recommended by the American Urological Association:
Risk Group | Classification |
|---|---|
Low Risk |
|
Intermediate Risk | Grade Group 2–3 or PSA 10 to <20 ng/mL or clinical stage T2b–c Favourable:
Unfavourable:
|
High Risk | Grade Group 4–5 or PSA ≥20 ng/mL or clinical stage T3 |
Prostate cancer risk grouping, according to the American Urological Association guidelines (2022).
Treatments based on prostate cancer risk groups
Following risk stratification, your doctor can then recommend appropriate management strategies and clinical trials for you to consider.
For example, those with low-risk cancer would likely only be recommended active surveillance, while those facing intermediate-risk cancer but with a favorable outlook can also consider radiation therapy and radical prostatectomy in addition to active surveillance.
If you are facing unfavorable intermediate- or high-risk prostate cancer, and expect to live for over a decade, you would likely be recommended radical prostatectomy or radiation therapy together with androgen deprivation therapy.
Those with high-risk cancer would also be recommended to undergo a bone scan or further imaging in order to check for metastasis beyond the prostate, an advanced stage of prostate cancer.
Currently, US guidelines recommend that you and your doctor discuss your case and conclude on the best treatment choice for you, based on your risk for cancer progression, your personal preferences, and how best to minimize toxic side effects. This is important, as how much you value preserving your urinary and sexual functions as compared to having a peace of mind about being completely cancer-free, will likely differ from other patients.
Considering the risk of progression, as well as how you wish to live your life after cancer will be a critical part of deciding your treatment plan with your doctor.
