Prostate Cancer: Grading, Risk & Staging
Prostate cancer management is risk-driven from the first day: the same diagnosis can mean "watch it" or "treat aggressively," and what separates them is grade (Grade Group), PSA, and stage.
The big picture
Prostate cancer management is risk-driven from the first day: the same diagnosis can mean "watch it" or "treat aggressively," and what separates them is grade (Grade Group), PSA, and stage. Master the Grade Group system and the low/intermediate/high risk buckets, and the entire treatment algorithm becomes logical — because every treatment decision flows from which risk bucket the patient lands in.
The framework: diagnose (PSA/DRE → biopsy) → grade with Grade Groups (Gleason) → stratify into low / intermediate / high risk (grade + PSA + stage) → stage the extent → match treatment to risk (next lesson).
Mechanism pathway
Tap any step to see why it happens.
Diagnostic algorithm
Each step answers one question. Tap to expand.
Board traps
Grade Groups: GG1 = Gleason ≤6, GG2 = 3+4, GG3 = 4+3, GG4 = 8, GG5 = 9–10.
3+4 (GG2) is better than 4+3 (GG3) — the first number is the dominant pattern.
Low risk = ≤T2a + PSA<10 + GG1; high risk = ≥T2c or PSA>20 or Gleason ≥8.
Risk group drives treatment — always classify before deciding.
mpMRI before biopsy improves detection of significant cancer.
Bone mets are osteoblastic; bone scan reserved for higher-risk; PSMA PET for sensitive staging/recurrence.