Prostate Cancer Risk Groups (EAU)
EAU risk groups for prostate cancer from PSA, ISUP grade group and clinical stage — the worst single factor sets the group. NICE NG131 (2021 update) uses the 5-tier Cambridge Prognostic Groups instead.
Score interpretation
EAU low risk: PSA < 10, ISUP grade group 1 and cT1–T2a.
→ Active surveillance preferred (NICE NG131). Criteria confirmed by mpMRI + systematic biopsies. AS protocol: PSA 3–6-monthly, annual confirmatory biopsy or MRI-targeted biopsy. No immediate treatment unless progression. Discuss all options: AS, RT, RP.
EAU intermediate risk: PSA 10–20, ISUP 2–3 or cT2b (no high-risk feature).
→ mpMRI + targeted biopsy if not done. Discuss: radical prostatectomy (RARP) vs EBRT ± brachytherapy boost. Short-term ADT (6 months) with RT for unfavourable intermediate risk (GG3). Active surveillance for selected GG2. MDT discussion. NICE NG131.
EAU high risk: PSA > 20, ISUP 4–5 or cT2c.
→ Staging: PSMA-PET/CT (preferred) or bone scan + CT. If M0: EBRT + long-term ADT (2–3 years) ± docetaxel intensification. RP for selected T3a with adequate margins intent. If M1: androgen deprivation + intensification (abiraterone, enzalutamide, or docetaxel per STAMPEDE). MDT mandatory. Bone protection (denosumab/zoledronate). NICE NG131.
EAU locally advanced: cT3–T4 or cN1, any PSA and grade.
→ Staging: PSMA-PET/CT (preferred) or bone scan + CT. If M0: EBRT + long-term ADT (2–3 years) ± docetaxel intensification. RP for selected T3a with adequate margins intent. If M1: androgen deprivation + intensification (abiraterone, enzalutamide, or docetaxel per STAMPEDE). MDT mandatory. Bone protection (denosumab/zoledronate). NICE NG131.
Interpretation bands for the PCa Risk. Apply clinical judgement and local guidance.
References
- NICE NG131. Prostate cancer: diagnosis and management. 2019 (updated 2021).
- EAU Guidelines on Prostate Cancer. 2023.
Related
Curated clinical cross-links plus same-class fallbacks.
- Gleason Score / Grade Group for Prostate Cancer · Prostate Cancer
- UCSF-CAPRA Score for Prostate Cancer · Prostate Cancer
- PSA Doubling Time (PSADT) Calculator · Prostate Cancer
- D'Amico Risk Classification for Prostate Cancer · Prostate Cancer
- PSA Velocity and PSA Density · Prostate Cancer
- D'Amico Risk Stratification for Localised Prostate Cancer · Prostate Cancer
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Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.