Prostate Cancer Risk Stratification (NICE / EAU)
Risk stratification for localised/locally advanced prostate cancer using PSA, Gleason grade group, and clinical stage to guide treatment planning.
Score interpretation
Low-risk localised prostate cancer. PSA < 10, GG1, T1–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.
Intermediate-risk localised prostate cancer. PSA 10–20, GG2–3, or T2b–T2c.
→ 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.
High-risk or locally advanced prostate cancer. PSA > 20, GG4–5, or T3+.
→ 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.