When a patient has a positive biopsy for prostate cancer the next important step is to stage the disease. "Staging" is used to evaluate disease progression (how far the cancer has spread) in each patient and is based on PSA level at the time of diagnosis, Digital Rectal Examination (DRE) and histology result (Gleason Grade). According to those, disease is categorized in each of the three risk groups: low, intermediate or high.

Gleason Score (6-10) or Grade (1-5) on biopsy describes how closely tumor cells resemble normal prostate cells. A low grade means that cells look almost normal and a high (4, or 5) that cells are very abnormal. The higher the grade the more aggressive is the disease. Staging is completed with a CT scan of abdomen and pelvis and a whole body bone scan. In locally advanced disease seminal vesicle biopsy, PET PSMA CT scan or pelvic lymph node dissection may be required.

Low-risk patients are those possessing all three low-risk features (table 1) and any type of monotherapy (radical prostatectomy, brachytherapy or external beam radiation) will offer them highest cure rates. Intermediate-risk patients are those that possess one intermediate risk feature (table 1). Patients with two or more intermediate features might be considered high-risk. True high-risk patients are those that possess at least one of the high-risk features. Intermediate and high-risk patients can be treated with a combination of two or three different tratment modalities in order to achieve the highest cure rates.

 

	Low risk	Intermediate risk	High risk
PSA level	< 10	10 - 20	> 20
Gleason Grade	1	2 or 3	4 or 5
Clinical Stage	≤ T2a	T2b or T2c	> T2c

Table 1: Prostate cancer patients risk groups