Risk, Grade & More Prostate Cancer Terms To Know
- When a man is diagnosed with prostate cancer, there are several factors that go into determining how aggressive the disease is, how likely it is to spread and cause problems, and the best treatment approach.
- To help make sense of the grading system for patients, Dr. Shirin Razdan, director of the robotic surgery department at the Comprehensive Urological Surgery Institute in Miami, likens it to categorizing hurricanes.
- “[Grade] 1 is a weak hurricane. It’s not going to cause too much damage, your house is going to be upright, maybe there’s a trash can that falls over … but grade group 5 or a category 5 hurricane can cause serious damage and it’s very aggressive prostate cancer,” she explains.
- Your risk category — low, intermediate, or high — plays a major role in guiding your treatment plan and options.
To help make sense of the grading system for patients, Dr. Shirin Razdan, director of the robotic surgery department at the Comprehensive Urological Surgery Institute in Miami, likens it to categorizing hurricanes.
Read MoreHow Do Doctors Determine Risk?
Once someone is diagnosed with prostate cancer, one of the first and most important steps in managing the disease is called risk stratification. Risk stratification is the process your doctor uses to determine how aggressive your cancer is and how urgently it needs to be treated. In other words, it’s how doctors assess the severity of your disease to personalize your treatment plan.Prostate cancer is not a one-size-fits-all condition. Some types grow very slowly and may never cause symptoms or require active treatment, while others can grow quickly and spread to other parts of the body. That’s why this early classification is so important — it guides the entire course of care.
The three risk groups are low, intermediate, and high.
- Low-risk prostate cancer tends to grow slowly and may not require immediate treatment. In many cases, patients can safely choose a strategy called active surveillance, where the cancer is closely monitored over time.
- Intermediate-risk prostate cancer is more likely to grow or spread and usually requires treatment. Options might include surgery, radiation therapy, or a combination of therapies.
- High-risk prostate cancer is more aggressive and has a higher chance of spreading. These patients often need a more intensive treatment plan, sometimes combining radiation, hormone therapy, and surgery.
This classification is based on three key factors: TNM staging, PSA levels, and the Gleason Score. Let’s take a closer look at each.
TNM Staging
TNM stands for tumor, node, and metastasis. It’s a universally accepted system used to describe how far a cancer has spread.
T (Tumor) describes the size and extent of the main (primary) tumor in the prostate. A T1 tumor is very small and not detectable by physical exam, while a T3 or T4 tumor has grown outside the prostate and possibly into nearby structures.
N (Node) refers to whether the cancer has spread to nearby lymph nodes. Lymph nodes are small immune system glands that can act as a highway for cancer spread. N0 means no lymph nodes are involved; N1 means cancer has spread to nearby lymph nodes.
M (Metastasis) indicates whether the cancer has spread to other parts of the body (bones, liver, lungs, etc.). M0 means no distant spread; M1 means the cancer has metastasized.
Understanding the TNM stage helps doctors gauge how advanced the cancer is. For example, a cancer confined to the prostate (T1–T2, N0, M0) is often considered low or intermediate risk, depending on the other two factors.
What Is The Gleason Score?
The Gleason score is a way of grading how abnormal the prostate cancer cells look under a microscope. It provides insight into how likely the cancer is to grow and spread.
A pathologist examines the prostate tissue obtained from a biopsy and assigns two grades based on the most common cell patterns seen in the sample.
Each is graded on a scale from 1 to 5, where grade 1 resembles normal prostate tissue, while grade 5 looks very abnormal. These two numbers are added together to form the Gleason score (e.g., 3 + 4 = 7). The higher the total score, the more aggressive the cancer is considered to be.
- Gleason 6 (3+3): Low-grade cancer (less aggressive)
- Gleason 7 (3+4 or 4+3): Intermediate-grade cancer
- Gleason 8-10: High-grade cancer (more aggressive)
Doctors also sometimes use grade groups, which simplify the Gleason score into five categories from 1 (least aggressive) to 5 (most aggressive).
How Does PSA Fit In?
PSA, or prostate-specific antigen, is a protein made by the prostate. It can be measured with a simple blood test.
While a high PSA level doesn’t automatically mean you have prostate cancer, it is often one of the first signs that something may be wrong. PSA is also used to track the progression of the disease and to monitor how well treatments are working.
Here’s how PSA levels relate to risk:
- PSA < 10 ng/mL: Often considered low risk
- PSA 10–20 ng/mL: Intermediate risk
- PSA > 20 ng/mL: High risk
Doctors interpret PSA levels along with the Gleason score and TNM stage to get a full picture of your disease.
Treatment Options Based On Risk
Your risk category plays a major role in guiding your treatment plan.
Patients with low-risk disease may not need immediate treatment. In fact, many choose active surveillance, which involves regular monitoring through PSA tests, physical exams, and occasional biopsies. This approach avoids or delays treatment side effects, such as incontinence or erectile dysfunction.
If treatment is preferred, options may include:
- Radical prostatectomy (surgical removal of the prostate)
- Radiation therapy
However, these are often reserved for younger patients or those with other risk factors.
Patients with intermediate risk disease have a higher likelihood of progression and usually need active treatment. Options may include:
- Radiation therapy, sometimes combined with short-term hormone therapy to reduce testosterone levels and improve outcomes
- Radical prostatectomy with possible removal of nearby lymph nodes
In selected cases, brachytherapy (internal radiation) may be used. Patients may also participate in clinical trials or receive genomic testing to better personalize therapy.
For high-risk patients, a more aggressive approach is usually required. This may include:
- External beam radiation therapy plus long-term hormone therapy (sometimes for 18-36 months)
- Radical prostatectomy with extended lymph node dissection, sometimes followed by radiation
- Newer therapies, including chemotherapy, PARP inhibitors, or radiopharmaceuticals, may also be considered for advanced or recurrent disease
Some patients are also eligible for clinical trials involving novel drugs, immunotherapies, or genetic testing to match them with precision treatments.
Questions To Ask Your Doctor
- What is my risk level?
- How will I be monitored to determine if my risk level changes?
- What is the most common treatment for people with my risk level?
- What are the pros and cons of treatment vs. active surveillance?
Content independently created by SurvivorNet with support from Novartis Pharmaceuticals Corp.
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