Understanding Your Prostate Cancer Diagnosis: 5 Things to Know

After a prostate cancer diagnosis, the way your doctor describes your cancer can help you understand what to expect next. “Low-risk cancers often use active surveillance. Intermediate-risk cancers typically require surgery or radiation. And high-risk cancers need aggressive treatment, often combining therapies,” said Neeraj Agarwal, MD, FASCO, an American Society of Clinical Oncology (ASCO) expert and medical oncologist at the Huntsman Cancer Institute at the University of Utah.

What makes prostate cancer low, intermediate, or high risk? And what do each of the terms used to describe your cancer mean for you?

1. You may have problems with your prostate that aren’t cancer.

During the diagnosis process, your doctor might discover issues with your prostate. But those problems are often low risk and benign (meaning not cancerous). For instance, the doctor might find prostate nodules during an exam. These are firm lumps or hardened areas in the prostate. While nodules can be cancerous, they can also be caused by non-cancerous conditions. Examples of benign conditions include enlarged prostate tissue (also called benign prostatic hyperplasia, or BPH) and inflammation of the prostate.

If you have problems other than cancer in your prostate, your doctor will talk to you about how those conditions might affect your cancer risk. They will also address any additional testing you might need.

2. There’s a difference between “stage” and “grade.”

Your doctor will let you know the stage and grade of your cancer. The stage and grade can help guide your treatment options and predict your prognosis.

“Stage,” or staging,  describes if and how much the cancer has spread outside of the prostate. The main stages of prostate cancer range from stage I (1) through stage IV (4). The lower the number, the less the cancer has spread. Prostate cancer is considered low risk if it is found only in the prostate gland and is likely to grow very slowly. A higher number means cancer has spread more. If your care team finds cancer cells that have spread beyond the prostate, the cancer is considered higher risk.

“Grade,” or grading, describes how aggressive the cancer is. This is determined by how abnormal the cancer cells look under a microscope.  Low-grade cancer is less likely to grow and spread. High-grade cancer is more likely to grow and spread.

“Think of grade as the cancer’s personality,” said Dr. Agarwal. “Grade predicts the cancer’s behavior, like whether it will grow slowly or quickly.”

Because prostate cancers often have areas in the tumor with different grades, a doctor (pathologist) assigns a grade of 1 to 5 to the two areas that make up most of the cancer. A grade of 1 (and often 2) means the cells look like normal prostate tissue. Grade 5 means the cells look very abnormal.

3. Your cancer will be assigned a Gleason score.

Once your doctor knows the grades of the two areas of prostate cancer, they can determine its Gleason score. The two grading numbers are added together to determine the Gleason score. The first number is the grade that is most common in the tumor.

Because grades 1 and 2 are considered normal prostate tissue, doctors typically use a scale of 3 to 5 for each cancerous area. This means that 6 is the lowest Gleason score a prostate cancer could receive. For example, if the Gleason score is written as 3 + 4 = 7, it means most of the tumor is grade 3 and less of it is grade 4. Adding the two numbers together results in a Gleason score of 7. 

Here are examples of what Gleason scores between 6 (lowest) and 10 (highest) mean:

• A Gleason score of 6 means the cancer is low grade and growing slowly (low risk).
• A Gleason score of 7 means the cancer is intermediate grade and risk.
• A Gleason score of 8 to 10 means the cancer is high grade and growing quickly (high risk).

“In the localized setting, your Gleason score helps determine treatment urgency and options,” said Dr. Agarwal. (A localized setting means that the cancer is only in the prostate and has not spread.) “Lower scores may allow active surveillance, while higher scores typically require treatment with surgery or radiation right away.”

4. You can live a long life even with a metastatic prostate cancer diagnosis.

Metastatic prostate cancer is the most advanced prostate cancer diagnosis. Metastatic means the cancer has spread outside the prostate to other parts of the body. Although living with metastatic prostate cancer can be challenging, people with this diagnosis can still live for a long time.

Most often, prostate cancer spreads to the bones. “In more than 80% of patients whose prostate cancer has spread beyond the pelvic area, the cancer spreads to the bones, like the spine or hips,” said Dr. Agarwal. “Median survival of patients with newly diagnosed prostate cancer that has spread to the bones has improved over the last decade. Based on the results of recent clinical trials, it is now approaching 5 years.”

Survival rates for people with metastatic prostate cancer continue to improve with advances in treatment. For example, one recent study presented at the 2025 ASCO Annual Meeting identified a new treatment that could slow cancer growth for some people with metastatic hormone-sensitive prostate cancer (mHSPC). This type of cancer relies on male hormones called androgens to grow.

5. Your doctor will look at more than just cancer to guide your treatment plan.

While all the factors above play an important role in deciding on your treatment plan, Dr. Agarwal noted that your doctor will consider other factors as well.

These factors include:

• Your age
• Your overall health
• Your life expectancy
• Concerns about sexual, urinary, and bowel function
• Your priorities for quality of life
• Your personal preferences
• Practical considerations, like what treatments are available and what support systems you have in place

It’s important to talk with your doctor about your specific diagnosis, your cancer’s risk level, and all possible treatment options. What’s most important is for you to make the best treatment decision for yourself.

Questions to ask include:

• What are the stage, grade, and Gleason score of my cancer?
• What are all my treatment options and their success rates?
• What are the side effects of each treatment, including sexual, urinary, and bowel function?
• What do you think is the best treatment for me, and why?
• How urgent is treatment? Do I have time for a second opinion?
• What’s my prognosis with and without treatment?
• Are there any clinical trials that may be an option for me?

Learn more about prostate cancer from the American Cancer Society:

• Prostate Cancer Causes, Risk Factors, and Prevention
• Prostate Cancer Early Detection, Diagnosis, and Staging
• Treating Prostate Cancer
• Understanding Your Pathology Reports: Benign Prostate Conditions
• Understanding Your Pathology Reports: Prostate Cancer
• Anatomy Gallery: Male Genitourinary System

Dr. Agarwal is a member of ASCO’s Patient Information Editorial Board.