Risk Groups for Localized Prostate Cancer

For cancers that have not spread (stage I to III cancers), many doctors now use information about the cancer (such as the T category, initial PSA level, grade group, and prostate biopsy results) to divide them into the following risk groups: 

  • Very low 
  • Low
  • Intermediate (favorable or unfavorable)
  • High
  • Very high

The risk group can help determine if any further tests should be done, as well as help guide initial treatment options. Cancers in lower risk groups have a smaller chance of growing and spreading compared to those in higher risk groups.

If you have prostate cancer that has not spread to nearby lymph nodes or to other parts of the body, you might want to ask your doctor what risk group your cancer falls into to understand your treatment choices. 

Other ways to assess risk of prostate cancer growing and spreading

In addition to the clinical risk groups above, doctors are still learning about the best use of other types of tests and prognostic models to help decide the most effective treatment options for someone. If your doctor suggests using one of these ways to help determine your treatment options, have them explain what it can tell you, as well as how accurate it’s likely to be.

Gene and protein tests for prostate cancer

For men with prostate cancer that is localized (not thought to have spread outside the prostate), a major issue is that it’s often hard to tell how quickly the cancer is likely to grow and spread. This can make it hard to decide if the cancer needs to be treated right away, as well as which types of treatment might be good options. 

Some types of lab tests, known as genomic, molecular, or proteomic tests, can be used along with other information (such as the risk groups above) to help better predict how quickly a prostate cancer might grow or spread, and as a result, help decide what treatment options might be best and when they should be given. These tests look at which genes or proteins are active inside the prostate cancer cells. Examples of such tests include:

  • Oncotype DX Prostate: This test measures the activity of certain genes in prostate cancer cells and reports it as a score on a scale from 0 to 100 (higher scores indicate a cancer that is more likely to grow and spread quickly, as well as a higher risk of dying from prostate cancer). 
  • Prolaris: This test measures the activity of a different set of genes in prostate cancer cells and reports it as a score on a scale from 0 to 10 (higher scores indicate a cancer that is more likely to grow and spread quickly, as well as a higher risk of dying from prostate cancer).
  • ProMark: This test measures the activity of a set of proteins in prostate cancer cells and reports it as a score that helps predict how likely a cancer is to grow and spread quickly.
  • Decipher: For men who choose surgery to treat their cancer, this test can help determine the risk that the cancer will come back in other parts of the body after surgery (and therefore if these men should consider further treatment). This test measures the activity of certain genes in prostate cancer cells from the surgery tissue.

These tests continued to be studied to find more areas where they can be useful in prostate cancer risk and treatment decisions.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Joint Committee on Cancer. Prostate. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017: 715-725.

Klein EA. Prostate cancer: Risk stratification and choice of initial treatment. In Savarese DMF, ed. UpToDate. Waltham, Mass.: UpToDate, 2021. https://www.uptodate.com. Last updated May 7, 2021. Accessed August 30, 2021.

National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Prostate Cancer. Version 1.2022. Accessed at www.nccn.org/professionals/physician_gls/pdf/prostate.pdf on October 4, 2021.

Ross A, D’Amico AV, Freedland S. Molecular prognostic tests for prostate cancer. In Savarese DMF, ed. UpToDate. Waltham, Mass.: UpToDate, 2021. https://www.uptodate.com. Last updated July 2, 2021. Accessed October 4, 2021.

References

American Joint Committee on Cancer. Prostate. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017: 715-725.

Klein EA. Prostate cancer: Risk stratification and choice of initial treatment. In Savarese DMF, ed. UpToDate. Waltham, Mass.: UpToDate, 2021. https://www.uptodate.com. Last updated May 7, 2021. Accessed August 30, 2021.

National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Prostate Cancer. Version 1.2022. Accessed at www.nccn.org/professionals/physician_gls/pdf/prostate.pdf on October 4, 2021.

Ross A, D’Amico AV, Freedland S. Molecular prognostic tests for prostate cancer. In Savarese DMF, ed. UpToDate. Waltham, Mass.: UpToDate, 2021. https://www.uptodate.com. Last updated July 2, 2021. Accessed October 4, 2021.

Last Revised: October 8, 2021

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.