Before planning your treatment, your prostate cancer doctors will take a close look at your risk group, which is a way categorizing the overall severity of a case and applying evidence and experience to determine how aggressively your treatment should be. There are 3 general risk groups based on the PSA, DRE, and biopsy, which can further be subdivided to better personalize treatment for each patient.
- Low risk: Tumor is confined to the prostate, and the PSA is <10 and grade group 1 (Gleason 6). There is also a subset of extremely “slow-growing” tumors called “very low risk” in which fewer than 3 biopsy tissue samples contain cancer cells and the cancer is not detectable by DRE.
- Intermediate risk: Tumor is confined to the prostate, the PSA is between 10 and 20, or grade group 2 or 3 (Gleason 7). This category is often divided into a “favorable” and “unfavorable” intermediate risk.
- High risk: Tumor extends outside the prostate, the PSA >20, or grade group 4 or 5 (Gleason 8 to 10). There is also a subset of very aggressive tumors is called “very high risk” in which the tumor has extended into the seminal vesicles (T3b) or the rectum or bladder (T4), or there are multiple biopsy samples with high grade cancer.
These risk groups are not perfect indicators of your risk for developing recurrent, aggressive prostate cancer. Currently, there are extensive, ongoing efforts to develop tests that can aid physicians in more accurately telling the difference between cancers that will become fatal from those that will sit in the prostate without spreading.
The treatment options for each risk group are very different and you should ask your doctor which risk group you belong to so you can better understand the most appropriate next steps.