NCCN Risk Categories for Prostate Cancer

Decisions about the best way to treat your prostate cancer are never made lightly. A great deal of thought and careful review of test results, cancer data and your medical history are all considered when determining which treatment option is best for your individual prostate cancer.

In our last blog, we looked at the way physicians stage and grade prostate cancer. Now we will look at one other important classification that is part of the evaluation process—risk category. Risk category refers to a classification system established by the highly respected National Comprehensive Cancer Network (NCCN)—a nonprofit alliance composed of 25 of the world’s leading cancer centers. Led by renowned cancer experts, the NCCN has formulated standardized guidelines for nearly every type of cancer to help ensure patients receive the highest quality care and most effective treatment possible.

After a man is diagnosed with prostate cancer, the NCCN recommends that his cancer be classified as one of four risk categories—very low risk, low risks, intermediate risk or high risk. The surgeons at USMD Prostate Cancer Center say the category provides them with a good idea about whether or not the prostate cancer is likely to spread to other parts of the body. Like staging and grading, several factors are taken into consideration when determining a man’s risk category—PSA level, size of the prostate, results from a needle biopsy, and the stage of prostate cancer. Knowing the risk group helps us determine the best treatment option.

Here are the benchmarks for each risk category.

VERY LOW RISK
Fifteen percent of newly diagnosed cases of prostate cancer are defined as very low risk. Men who are classified as very low risk meet the following criteria:

• Stage T1c
• PSA less than 10 ng/mL
• Gleason score 6 or less
• Not more than two cores with cancer
• Less than 50 percent of core involved with cancer
• PSA density less than 0.15

For men in this category, the NCCN recommends active surveillance as the appropriate treatment option when the man’s life expectancy may be less than 20 years.

LOW RISK
Roughly 35 percent of newly diagnosed cases of prostate cancer fall into this category. Men who are classified as low risk meet the following criteria:

• Stage T1c or T2a
• PSA less than 10 ng/mL
• Gleason score less than 6

For men classified as low risk, the NCCN recommends active surveillance as an appropriate treatment option for men whose life expectancy may be less than 10 years. For men who have an anticipated life expectancy of more than 10 years, active surveillance may be followed by surgery or radiation.

INTERMEDIATE RISK
About 40 percent of men diagnosed with prostate cancer for the first time are considered intermediate risk. Men who are classified as intermediate risk meet the following criteria:

• Stage T2b-T2c or
• PSA 10 to 20 ng/mL or
• Gleason score 7

The NCCN recommends two treatment options for men in the immediate risk category with less than 10 years of anticipated life expectancy—active surveillance or external radiation. If external radiation is selected, it may be used with or without hormonal therapy.

For men with more than a decade of anticipated life expectancy, the NCCN recommends surgery or external radiation. External radiation may be used with or without hormonal therapy, or with or without brachytherapy.

HIGH RISK
Nearly 10 percent of men newly diagnosed with prostate cancer are considered high risk. Men who are classified as high risk meet the following criteria:

• Stage T3a
• PSA 20 ng/mL or higher
• Gleason score 8 or higher

Surgery or radiation hormonal therapy are the NCCN’s recommended treatment options for men in the high risk category.

Clearly understanding whether your individual cancer poses a low risk or high risk of being an aggressive cancer provides important insights that help you and the surgeons at USMD Prostate Cancer Center make well-informed decisions about how to treat your individual cancer for the best possible outcome.

If you or a loved one have questions about next steps or treatment options following a PSA test, digital rectal exam or biopsy, talk with one of the board-certified urologists at USMD Prostate Cancer Center. Click to Request A Call Back or Call us today at 1-888-PROSTATE to schedule an appointment.

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