Stages, types and grades of prostate cancer
Doctors divide prostate cancer that hasn't spread into groups. This helps them recommend if you need treatment and the type of treatment you need. They use different systems to do this. These are:
the Cambridge Prognostic Group (CPG)
risk groups
In the UK, doctors now use the Cambridge Prognostic Group (CPG) for prostate cancer that hasn't spread. This divides prostate cancer into 5 prognostic groups. The term prognostic refers to your outlook ( ). So your prognostic group tells you how likely it is that your cancer will grow or spread. And how likely it is that you will die from your cancer.
There are 5 groups, from CPG1 to CPG5.
Some doctors may still use an older, different system. This divides prostate cancer into 3 risk groups. In this system, risk refers to how likely it is that cancer will come back after treatment. The groups are:
low risk prostate cancer
medium or intermediate risk prostate cancer
high risk prostate cancer
If your cancer has spread
When prostate cancer spreads to another part of your body, it is called metastatic prostate cancer. Doctors don't use prognostic groups or risk groups for prostate cancer that has spread.
Read about metastatic prostate cancer
Doctors look at your test results and scans to put you in a prognostic group from 1 to 5. They look at the:
Grade Group or Gleason score
prostate specific antigen (PSA) level at time of diagnosis
tumour stage - this is the T stage from the TNM staging
The Grade Groups tell you how much the cancer cells look like normal cells. A specialist doctor called a pathologist looks at several samples of cells from your prostate. These are biopsies.
They then grade each sample based on how quickly they are likely to grow and how aggressive the cells look. Grade Groups have replaced the older system called the Gleason score.
Find out more about the Grade Groups
PSA is a protein made by both normal and cancerous prostate cells. A PSA level higher than what would be expected for someone of your age can be a sign of prostate cancer.
Read more about a PSA test and how you have one
The tumour stage describes how far the cancer has grown in the prostate. There are 4 main T stages of prostate cancer – T1 to T4.
This is a simplified description of the 4 T stages:
T1 means the cancer is too small to be seen on a scan or felt during an examination of the prostate.
T2 means the cancer is completely inside the prostate gland.
T3 means the cancer has clearly broken through the capsule (covering) of the prostate gland.
T4 means the cancer has spread into other organs nearby such as the bladder.
Read more about the different Tumour stages of prostate cancer
Below is a description of the 5 CPG groups. Ask your doctor or specialist nurse if you have any questions about your CPG group.
You have:
Grade Group 1 (previously called a Gleason score of 6)
and a PSA level less than 10 nanograms per millilitre (ng/ml)
and a T stage of 1 or 2
You have:
Grade Group 2 (previously called a Gleason score of 3 + 4 = 7)
or a PSA level between 10 and 20 ng/ml
and a T stage of 1 or 2
You have:
Grade Group 2 (previously called a Gleason score of 3 + 4 = 7)
and a PSA level between 10 and 20 ng/ml
and a T stage of 1 or 2
Or
Grade Group 3 (previously called a Gleason score 4 + 3 = 7)
and a T stage of 1 or 2
You have one of the following:
Grade Group 4 (previously called a Gleason score of 8)
PSA level higher than 20 ng/ml
T stage of 3
You have two or more of the following:
Grade Group 4 (previously called a Gleason score of 8)
PSA level higher than 20 ng/ml
T stage of 3
Or
Grade Group 5 (previously called Gleason score 9 to 10)
Or
T stage of 4
Some doctors may still use an older system. This divides prostate cancer into 3 risk groups. The term risk refers to how likely it is that your cancer will come back after treatment.
But the National Institute for Health and Care Excellence (NICE) now recommends the CPG system instead. This is because research has found that the CPG is a more accurate way to group prostate cancer and make treatment decisions.
NICE is an independent organisation that provides guidance to the NHS in England to improve healthcare.
Ask your doctor if you aren’t sure about your stage, Gleason score and PSA level. Or if you have questions about your risk group.
Low risk prostate cancer - doctors consider this to be similar to CPG 1.
Medium or intermediate risk prostate cancer - doctors consider this to be similar to CPG 2 and CPG 3.
High risk prostate cancer - doctors consider this to be similar to CPG 4 and CPG 5.
Your CPG helps your doctor recommend if you need treatment. And if so, the type of treatment you need. Treatment also depends on:
your age and general health
how you feel about the treatments and side effects
If you have CPG 1 or CPG 2 prostate cancer
Your doctor might not recommend treatment straight away. Sometimes your doctor may recommend monitoring your cancer. You only start treatment if the cancer begins to grow. Depending on your situation, they may call this:
active surveillance
watchful waiting
Treatment is also an option if you have CPG 1 or 2 prostate cancer and you are not keen on monitoring. You can read more about treatment options below.
If you have CPG 3, CPG 4 or CPG 5 prostate cancer
Your doctor might recommend you have treatment. For cancer that hasn't spread, treatment might include:
surgery to remove your prostate - this is called a prostatectomy
with or without
internal radiotherapy - this is called
If you have CPG 3 prostate cancer, your doctor might suggest active surveillance if you don’t want to have treatment straight away. Doctors don't offer active surveillance to people with CPG 4 and 5 prostate cancer.
Treatment as part of a clinical trial
Some treatments are only available as part of a clinical trial. These include:
Your doctor can tell you if one of these treatments might be an option for you.
Find out about treatments for prostate cancer
If your cancer has spread
This is called metastatic prostate cancer. You can read more about the treatment options in the section about metastatic prostate cancer.
Last reviewed: 22 May 2025
Next review due: 22 May 2028
You may have a choice of treatments such as surgery or radiotherapy. Or your doctor might suggest that they monitor your cancer instead of treatment straight away.
The Grade Group gives your doctor an idea of how the cancer might behave and what treatment you need. This is also known as the Gleason score.
The PSA test is a blood test that measures the amount of prostate specific antigen (PSA) in your blood. It can help to diagnose prostate cancer.
The TNM staging is a way of describing how far prostate cancer has grown. It stands for Tumour, Node, Metastasis.
You have a number of tests to check for prostate cancer. These may include a digital rectal examination, a PSA blood test, scans and a biopsy.
Prostate cancer is cancer that starts in the prostate gland. The prostate gland is found at the base of the bladder and is about the size of a walnut.
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