The results of tumour grading and staging investigations, along with PSA evaluation, are used to estimate the aggressiveness of the disease.1,2 Patients with clinically localised prostate cancer can be assigned to low, intermediate and high risk categories on the basis of T-stage, PSA level and Gleason score (see table below). Patients with T3 or T4 tumours are considered to have ‘locally advanced’ disease and those with less advanced T-stage but with high risk features (high Gleason score or PSA) may also be considered in this category.2 Patients with nodal metastasis (N+) can be designated as ‘very high risk’.1 Finally, patients with distant metastases (M+) may require a distinct management approach.1
Risk stratification for localised prostate cancer2
| PSA level | Gleason score | T-stage | |||
|---|---|---|---|---|---|
| Low risk | <10ng/ml | AND | ≤6 | AND | T1–T2a |
| Intermediate risk | 10–20ng/ml | OR | 7 | OR | T2b–T2c |
| High risk | >20ng/ml | OR | 8-10 | OR | T3–T4 |
References:
1. European Association of Urology. Guidelines on prostate cancer, 2010.
2. National Institute for Health and Clinical Excellence. Clinical guideline 58. Prostate cancer, February 2008.