Risk groups are a somewhat different way of classifying the likelihood of prostate cancer spread. Doctors use a combination of PSA test results, grade group, stage and other factors to separate prostate cancers into five risk groups: Very low risk Low risk Favorable intermediate Unfavorable intermediate High Very high Assigning a risk group to prostate cancer can help doctors work with patients to decide on the best treatment option.

What are the stages of prostate cancer?

The stage refers to whether the cancer has spread beyond the prostate, and if it has, the location in the body where it has spread. Doctors use the following information to stage prostate cancer: size of the tumor whether the cancer has spread to nearby lymph nodes the presence or absence of spread beyond the prostate and lymph nodes (metastasis) PSA levels at the time of diagnosis Gleason score

Get notified of page updates

Prostate Cancer: Grades and Stages

Q: Measuring prostate cancers for treatment decisions

Making decisions about prostate cancer treatment is not always straight forward. Doctors must weigh the risk of the cancer spreading and causing harm against the risks and side effects that come with surgery or treatment. Doctors use several factors to separate aggressive prostate cancers from those that are less likely to spread: Gleason score grade group risk group stage These measurements can help you and your doctor decide how best to treat your cancer.

Prostate cancer is treated according to its grade, Gleason score and stage. Learn how prostate cancers are classified.

Glossary on

off

Measuring cancers for treatment decisions

Making decisions about cancer treatment is not always straight forward. Doctors must weigh the risk of the cancer spreading and causing harm against the risks and side effects that come with surgery or treatment.

Doctors use several factors to separate aggressive cancers from those that are less likely to spread:

Gleason score
grade group
risk group

These measurements can help you and your doctor decide how best to treat your cancer.

Gleason score

Grade group

Table of Gleason scores and grade groups

Stage

Risk group

More resources

Gleason score, grade groups and risk groups

The grade of a cancer helps doctors predict how quickly the cancer is likely to grow and spread. This information helps doctors make decisions on how best to treat it.

For localized cancer ( cancer that has not spread beyond the ), doctors use two measures, the Gleason score and the grade group to categorize the grade of cancer.

Doctors use the grade group, , test results and other measures to group cancers by how likely they are to grow and spread.

What is a Gleason score?

The Gleason score is based on how abnormal the cells appear in the two largest areas of the tumor. The pathologist assigns a score of 1-5 for each area and adds them together for the Gleason score. Although Gleason scores can range from 2-10, most cancers will be scored as 6 or higher. The higher the score, the more abnormal and aggressive the cells appear. Using this measuring system, doctors label cancers as low, medium or high grade.

What is a grade group?

Doctors use the grade group scoring system to give them a better idea of how aggressive a cancer is likely to be. The grade group system uses the two Gleason score numbers to divide cancers into five separate categories in the table below.

Participate in Research

NePtune: Using PARP Inhibitors Before Surgery in Localized Prostate Cancer

Risk groups

Risk groups are a somewhat different way of classifying the likelihood of cancer spread. Doctors use a combination of test results, grade group, and other factors to separate cancers into five risk groups:

Very low risk
Low risk
Favorable intermediate
Unfavorable intermediate
High
Very high

Assigning a risk group to cancer can help doctors work with patients to decide on the best treatment option.

Table of Gleason scores, grade groups and risk groups

Gleason Score	Grade Group	Description	Risk Group
Gleason score 6	Grade group 1	These are considered low grade cancers. They tend to be slow-growing and less likely to spread.	Very low or low
Gleason score 7	Grade group 2	Grade group 2 cancers have a combined Gleason score of 7 (3+4). This means that larger portion of the cancer is Gleason score 3 than Gleason score 4. These are considered intermediate grade cancers. Grade group 2 cancers have a better outlook than grade group 3 cancers. Even though the total Gleason score is the same for both groups, grade group 2 has less aggressive cancer present.	Favorable intermediate or unfavorable intermediate
Gleason score 7	Grade group 3	Grade group 3 cancers have a combined Gleason score of 7 (4+3). This means that a larger portion of the cancer is Gleason score 4 than Gleason score 3. These are considered intermediate grade cancers. Grade group 3 cancers are considered more aggressive than grade group 2 cancers, even though the total Gleason score is the same for both groups.	Unfavorable intermediate
Gleason score 8	Grade group 4	These are high grade cancer. These are more aggressive and faster-growing cancers. For this reason, they are also known as high risk cancers.	High risk or very high risk
Gleason score 9-10	Grade group 5	These are high-grade cancer. These are more aggressive and faster-growing cancers. For this reason, they are also known as very high risk cancers.	High risk or very high risk

What are the stages of cancer?

The refers to whether the cancer has spread beyond the , and if it has, the location in the body where it has spread. Doctors use the following information to prostate cancer:

size of the tumor
whether the cancer has spread to nearby
the presence or absence of spread beyond the and ()
levels at the time of diagnosis
Gleason score

	Description
1	This is contained to the , has a Gleason score of 6 or below and a level of less than 10.
2	The cancer is more advanced but has not spread beyond the .
3	The cancer extends beyond the but has not spread to .
4 or	The cancer has spread to another part of the body outside of the . Common areas of spread include the bladder, rectum, or bones.

Additional tests for staging

Additional tests or imaging may be done to check for cancer spread to other parts of the body. These tests are not required for all newly-diagnosed cancer.

Additional tests are run if:

levels are high.
The Gleason score is high.
The cancer is large.
The cancer has spread to or beyond.

The tests may include:

Computed tomography (CT) scans of the abdomen and pelvis
Bone scans
Magnetic resonance imaging () of the pelvis
Positron emission tomography (PET) scans
- FDG PET scans use a radioactive sugar injected into the body to find cells with rapid growth. This is the older and more traditional form of .
- More frequently, doctors are using PSMA PET scans to look for cancer spread. Instead of injecting a radioactive sugar substance, this scan uses a radioactive form of (PSMA) to find cancer cells that may have spread to other places in the body.