Staging, grading and risk groups for prostate cancer

Knowing the stage, grade and risk group of the cancer helps your doctors plan the best treatment. Gleason is the most commonly used grading system for prostate cancer. Early prostate cancer is also divided into risk groups.

Staging of prostate cancer

The stage of a cancer describes its size and how far it has spread. The results of your tests help your doctors decide on the stage.

Doctors often use the TNM staging system or a number staging system for prostate cancer.

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TNM staging system

This gives information about:

  • the tumour (T)
  • whether the cancer has spread to any lymph nodes (N)
  • whether the cancer has spread to another part of the body, called metastasis (M).


Doctors put a number next to the T to describe the size and spread of the cancer.

  • T1 – the tumour is contained in the prostate. It is too small to be felt on a rectal examination or seen on a scan. It may have been diagnosed by a biopsy for a raised PSA level. Or, it may have been diagnosed by chance after surgery to remove part of the prostate to make peeing (passing urine) easier.
  • T2 – the tumour is still contained in the prostate. But it can be felt when the doctor does a rectal examination or is seen on a scan. T2 tumours are divided into:
  • T2a – the tumour is only in half of 1 of the 2 lobes of the prostate
  • T2b – it is in more than half of 1 lobe
  • T2c – it is in both lobes.

T1 and T2 tumours are not likely to affect the lymph nodes or to spread. Doctors call this early or localised prostate cancer.

  • T3 tumours have spread outside the prostate and may be growing into tissues close by:
    • T3a – the tumour has spread through the capsule surrounding the prostate.
    • T3b – the tumour has spread to the seminal vesicles that produce the fluid for semen.
  • T4 tumours have spread into areas close by, such as the bladder or back passage (rectum), or the muscle that controls peeing (passing urine).

T3 and T4 cancers are called locally advanced prostate cancer.

When the cancer has spread to another area, it is called advanced or metastatic prostate cancer.



  • M0 means the cancer has not spread to another part of the body, so locally advanced prostate cancer is always M0.
  • M1 means the cancer has spread to another part of the body, so advanced prostate cancer is always M1.

With the TNM staging system, advanced or metastatic prostate cancer can be any T, any N, and always M1.

You can talk to your doctor or specialist nurse about your TNM staging. They can explain it to you.

Number staging system

Number staging brings together different parts of the TNM staging system and gives it a number stage.

  • Stage 1
    The tumour is contained in the prostate.
  • Stage 2
    The tumour is bigger but still contained to the prostate.
  • Stage 3
    The tumour has started to break through the outer capsule of the prostate and may be in the nearby tubes that produce semen (seminal vesicles).
  • Stage 4
    The tumour has spread outside the prostate. It may have spread to areas such as the bladder or back passage (rectum). Or it may have spread further, for example to the bones.

Using the numbered staging system described above:

Related pages

Grading prostate cancer

A doctor decides the grade of the cancer by how the cancer cells look under the microscope. This information comes from your biopsy results.

The grade gives an idea of how quickly the cancer might grow or spread. Doctors use a combination of 2 systems to grade the cancer. These are called:

  • Gleason score
  • Grade Group.

Gleason score

Gleason is a commonly used grading system for prostate cancer. The Gleason score examines the pattern of cancer cells in the prostate tissue, and how they look and act, compared with normal cells.

There are 5 different patterns, graded from 1 to 5. Grade 1 and 2 looks like normal prostate tissue. But grade 5 is very different to normal tissue.

There may be more than 1 grade. The doctor examines all the biopsy samples taken and decides on:

  • the most common grade
  • the highest grade.

They add these together to give your Gleason score. A Gleason score of 7 could be:

  • 3 + 4 – The most common grade is 3 and the highest grade is 4.


  • 4 + 3 – The most common and highest grade are both 4, but there is also some grade 3 present.

What your Gleason score means

If your Gleason score is between 6 and 10, the cancer is:

  • Gleason score 6 – slow-growing
  • Gleason score 7 – intermediate-grade (between slow and fast-growing)
  • Gleason score 8 to 10 – high-grade (more likely to grow quickly).

Grade Group

This grades the cancer between 1 and 5 based on your Gleason score. The lower the Grade Group, the less likely the cancer is to grow and spread.

There are 5 Grade Groups:

  • Group 1 – Gleason score 6
  • Group 2 – Gleason score 7 (3+4)
  • Group 3 – Gleason score 7 (4+3)
  • Group 4 – Gleason score 8
  • Group 5 – Gleason score 9 to 10.

If you are in Group 3, where the highest grade is most common, you may need more treatment than Group 2.

Risk groups for prostate cancer

Prostate cancer is divided into risk groups.

Before planning your treatment, your cancer doctor will look closely at your risk group. This helps you and your doctors to decide on the best treatment for you. The treatment options for each risk group can be different.

Prostate cancer was previously grouped into low, intermediate or high risk groups. Doctors now use a more detailed system to work out your risk group. This is called the Cambridge Prognostic Group (CPG). It divides prostate cancer risk into 5 different groups. Your doctor may still describe your risk as low, moderate or high.

To work out your CPG risk group, your doctors look at:

  • the stage of the cancer
  • your PSA level (measured in nanograms per millilitre or ng/ml)
  • your Gleason score.

The 5 different CPG risk groups are:


The cancer has all of the following:

  • Stages T1
  • PSA less than 10 ng/ml
  • Gleason score 6 (grade group 1).


The cancer is Stages T1 -T2 and either:

  • PSA 10- 20 ng/ml


  • Gleason score 3 + 4 = 7 (grade group 2).


The cancer is Stage T1 -T2 and both:

  • PSA 10- 20 ng/ml
  • Gleason score 3 + 4 = 7 (grade group 2)

Or, the cancer is:

  • Stages T1–T2


  • Gleason 4 + 3 = 7 (grade group 3).


The cancer has 1 of the following:

  • Stage T3
  • PSA more than 20 ng/ml
  • Gleason score 8 (grade group 4).


The cancer has 2 or more of the following:

  • Stage T3
  • PSA more than 20 ng/ml
  • Gleason score 8 (grade group 4).

Or, the cancer is either of the following:

  • Stage T4
  • Gleason score 9 to 10 (grade group 5).

About our information

  • References

    Below is a sample of the sources used in our prostate cancer information. If you would like more information about the sources we use, please contact us at

    C. Parker, E. Castro, K. Fizazi, et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2020, Volume 31, Issue 9, p1119-1134. Available from

    National Institute for Health and Care Excellence (2019) Prostate cancer: diagnosis and management (NICE guideline NG131). Last updated December 2021 to include Risk stratification for localised or locally advanced prostate cancer. Available at


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editors, Dr Jim Barber, Consultant Clinical Oncologist and Dr Ursula McGovern, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

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Date reviewed

Reviewed: 01 October 2021
Next review: 01 October 2024
Trusted Information Creator - Patient Information Forum
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