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The difference between the 4 prostate cancer risk groups

close up of doctor consulting male patient with a clipboard

Prostate cancer is a complex disease that varies in its aggressiveness and potential to spread. To guide treatment decisions, healthcare providers often stratify patients with localized (Stages I to IIIC) prostate cancer into risk groups. 


These risk groups are based on clinical characteristics such as tumor stage, Gleason score, prostate-specific antigen (PSA) level, and biopsy results. Determining your tumor’s risk group and understanding what it means helps tailor treatment plans to your needs.

Very-low risk prostate cancer


With very-low-risk prostate cancer, tumors are small, localized, and slow-growing. These tumors are low-grade and your PSA level is less than 10 ng/ml.  

Treatment options

Treatment options for very-low-risk prostate cancer may include active surveillance (also known as watchful waiting) or observation, depending on your health and life expectancy. 


These two treatment options differ in how often your cancer is monitored and the extent of further testing. Active surveillance and observation aim to avoid overtreatment and its associated side effects while ensuring that treatment is initiated promptly and appropriately if the cancer shows signs of progression. 

Low-risk prostate cancer

If you have low-risk prostate cancer, tumors are small, localized, and slow-growing. These tumors are also low-grade and your PSA level is less than 10 ng/ml. However, biopsy results show more positive samples with cancerous cells than in the very-low-risk group. 

Treatment options

Treatment options for low-risk prostate cancer may include active surveillance or observation, or surgical removal of the prostate (radical prostatectomy). Based on the findings from prostate surgery, additional treatment, such as radiation therapy, with or without hormonal therapy, may be indicated. 

Intermediate-risk prostate cancer

With intermediate-risk prostate cancer, tumors may be larger and higher grade with your PSA between 10 and 20 ng/ml. This group is further divided into favorable or unfavorable intermediate-risk, depending on the clinical attributes of the cancer, as well as the results of a tumor biopsy. 

Treatment options

Based on whether the risk is favorable or unfavorable, treatment options for intermediate-risk prostate cancer may include surgery (radical prostatectomy), radiation therapy (external beam radiation with or without brachytherapy), or a combination of both. Hormonal therapy may also be considered to enhance the effectiveness of radiation therapy or surgery. 

High-risk or very-high-risk prostate cancer: 

High-risk and very-high-risk prostate cancer is characterized by more aggressive tumors that have a high likelihood of spreading beyond the prostate gland and causing significant morbidity or mortality. 


If you have high-risk prostate cancer, you may have tumors that are large, high-grade, or have spread to nearby tissues. Higher PSA levels may also be present. Very-high-risk cancer has multiple of these clinical characteristics while high-risk cancer has only one. 

Treatment options

Treatment options for these risk groups may include a combination of surgery, radiation therapy, and hormonal therapy to target cancer cells and reduce the risk of recurrence or spread. As with all prostate cancer risk groups, therapy decisions depend not only on the particular risk group, but on your age, health, and goals as well. 

Understanding your risk group

It’s important to remember that your risk group does not define your diagnosis. Be sure to speak to your care team about the different treatment options available and how they can be tailored to your needs.


If you have questions, you can connect with an Outcomes4Me oncology nurse practitioner at no charge through the Outcomes4Me app, using the “Ask Outcomes4Me” button.

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