Prostate Cancer Risk Assessment

Even if you do have cancer in your prostate, you may not need treatment right away — or at all. Many people with prostate cancer are diagnosed with indolent cancer which means it is growing slowly (or not at all) and unlikely to present problems or become life-threatening. Others, unfortunately, have aggressive forms that that are more likely to spread and become potentially life-threatening.

To help determine how to proceed, physicians make a Risk Assessment which estimates the chances that your cancer will cause future problems. Your risk assessment will be based on several factors, including:

  • Risk group – Your risk group is determined by PSA level, PSA density (ratio between the PSA and prostate size), Gleason score, tumor stage and findings from your biopsy. (more on Risk Groups below)
  • Life expectancy – The number of years you will likely live based on tables from the Social Security Administration. This can be adjusted based on your other health conditions and your performance status.
  • Nomograms – A mathematical method that predicts the course your cancer will take based on data from patients with prostate cancer with similar disease as yours.
  • Molecular tumor tests – to detect and/or measure certain molecules or biomarkers

What is my prostate cancer risk group?

You will be assigned to one of six risk groups ranging from very low risk to very high risk. Your risk group is based on the results and findings of several tests, including your:

  • PSA level and PSA density
  • Grade group (based on your Gleason score)
  • Tumor stage (based on the TNM staging system)
  • Biopsy (the number of biopsy cores that showed cancer)

Prostate cancer risk groups

Risk group PSA level Grade Group TNM score (tumor stage) Biopsy PSA density
Very low risk
Includes all of these
Less than 10 ng/mL 1 T1c Cancer in 1 to 2 biopsy cores with no more than half of each core showing cancer less than 0.15 ng/mL/g
Low risk
Includes all of these
Less than 10 ng/mL 1 T1 to T2a More than 3 biopsy cores show cancer, but less than half of all cores show cancer
Favorable intermediate risk
Includes all of these
10 to 20 ng/mL 1 or 2 T2b to T2c Less than half of biopsy cores show cancer
Unfavorable intermediate risk
Includes at least one
10 to 20 ng/mL 3 T2b or T2c More than half of biopsy cores show cancer
High risk
Includes only one
More than 20 ng/mL 4 or 5 T3a More than half of the biopsy cores show cancer, but less than 4 cores are Grade Group 4 or 5
Very high risk
Includes at least one
More than 20 ng/mL * T3b to T4 More than 4 biopsy cores are Grade group 4 or 5

* Gleason pattern 5 in the cancer cells that take up largest area in the tumor

Prostate cancer treatment