NCCN Guidelines for Patients
: Prostate Cancer
Part 5: Initial treatment by risk group
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5.1 Very low risk
Men at very low risk include those with a T1c
tumor, PSA level less than 10 ng/mL, PSA
density less than 0.15 ng/mL/g, Gleason score
6 or less, and cancer in fewer than three biopsy
cores and in half or less of any core.
5.2 Low risk
Men at low risk include those with a T1a, T1b,
T1c, or T2a tumor, PSA level less than 10 ng/
mL, and Gleason score 6 or less.
5.3 Intermediate risk
Men at intermediate risk include those with a T2b
or T2c tumor, PSA level between 10 and 20 ng/
mL, or Gleason score 7. If you meet more than
one criterion, your risk is high.
5.4 High risk
Men at high risk include those with a T3a tumor,
a PSA level greater than 20 ng/mL, or a Gleason
score between 8 and 10. If you meet more than
one criterion, your risk is very high.
5.5 Very high risk
Men at very high risk include those with a T3b or
5.6 Metastatic disease
Men with metastatic disease include those with
N1 or M1 disease.
Part 5 is a guide to the initial treatment options for men
with prostate cancer. The information in this guide is
taken from the treatment guidelines written by NCCN
experts for prostate cancer doctors. However, your
doctors may suggest other treatments based on your
health and personal wishes.
Groups based on the prognosis of the cancer are used
to recommend treatment options. There are six risk
groups. These risk groups have been tested and were
found to predict treatment outcomes well. They provide
a better basis for treatment recommendations than just
using the stage of cancer.
You must know your level of risk to find which treatment
options are best for you. If you don’t know your risk,
ask your doctor for the results of your PSA tests, biopsy
tests, and the stage of the cancer. The criteria for each
risk group are: