How is prostate cancer risk stratified?

Updated: Mar 23, 2020
  • Author: Natasza M Posielski, MD; Chief Editor: E Jason Abel, MD  more...
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Prostate cancer risk stratification is based on groups defined by D’Amico et al in 1998. This system has been adopted by the National Comprehensive Cancer Network (NCCN) and is used widely in clinical practice when making decisions regarding treatment and/or active surveillance. [2, 4]

Table 4. Anatomic stage/prognostic groups (Open Table in a new window)






Grade Group

I cT1a-c, cT2a N0 M0 < 10 ng/ml 1
pT2 N0 M0 < 10 ng/ml 1
IIA cT1a-c, cT2a N0 M0 ≥10, < 20 ng/ml 1
pT2 N0 M0 ≥10, < 20 ng/ml 1
cT2b-c N0 M0 < 20 ng/ml 1
IIB T1-2 N0 M0 < 20 ng/ml 2
IIC T1-2 N0 M0 < 20 ng/ml 3
T1-2 N0 M0 < 20 ng/ml 4
IIIA T1-2 N0 M0 ≥20 ng/ml 1-4
IIIB T3-4 N0 M0 Any 1-4
IIIC Any N0 M0 Any 5
IVA Any N1 M0 Any Any
IVB Any Any M1 Any Any


*If PSA or Gleason is not available, grouping should be determined by T stage and/or either PSA or Gleason, as available.

See Prostate Cancer: Diagnosis and Staging, a Critical Images slideshow, to help determine the best diagnostic approach for this potentially deadly disease.

Also see the Advanced Prostate Cancer: Signs of Metastatic Disease slideshow for help identifying the signs of metastatic disease.

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