Quick Reference
Key terminology, risk stratification, and clinical decision points at a glance.
Risk Stratification for Localised Cancer
| Risk Category | T Stage | Gleason Grade Group | PSA Level |
|---|---|---|---|
| Low Risk | T1/T2 | 1 | <10 ng/ml |
| Intermediate Risk | T1/T2 | 2 or 3 | <20 ng/ml |
| High Risk | T3/T4 | 4 or 5 | ≥20 ng/ml |
Multiparametric MRI Likert Scale
Very Low
Consider omitting biopsy (after shared decision)
Low
Consider omitting biopsy (after shared decision)
Intermediate
Offer mpMRI-influenced biopsy
High
Offer mpMRI-influenced biopsy
Very High
Offer mpMRI-influenced biopsy
Staging Scan Decision Tree
Offer Bone Scan & CT Abdomen/Pelvis if:
✓ Gleason grade group ≥ 3
✓ PSA ≥ 10 ng/ml AND Gleason grade group ≥ 2
Do NOT routinely offer if:
✗ Gleason grade group = 1
✗ PSA < 10 ng/ml AND Gleason grade group = 2
Key Terminology
Active Surveillance
Regular monitoring of localised prostate cancer with the intention to offer curative treatment if disease progression is detected.
Gleason Grade Group
A simplified grading system (1-5) for prostate cancer aggressiveness. Group 1 is least aggressive, Group 5 is most aggressive.
Localised Prostate Cancer
Cancer confined to the prostate gland (T1/T2 stage).
Locally Advanced Prostate Cancer
Cancer that has spread outside the prostate gland but has not spread to distant parts of the body (T3/T4 stage).
Metastatic Prostate Cancer
Cancer that has spread to distant parts of the body (bones, lymph nodes, organs).
Multiparametric MRI (mpMRI)
Advanced MRI scan using multiple parameters (T2-weighted, diffusion-weighted, dynamic contrast-enhanced imaging) to assess the prostate.
Likert Score
A 5-point scale used to report mpMRI results. Score 1-2 indicates low likelihood of clinically significant cancer; 3-5 indicates higher likelihood.
Watchful Waiting
Monitoring of localised prostate cancer with the intention to offer palliative treatment if disease progression is detected. Curative treatment is not attempted.
PSA (Prostate-Specific Antigen)
A protein produced by the prostate gland. Elevated levels may indicate cancer, but can also be elevated in benign conditions.
T Stage
Tumour stage classification. T1/T2 = localised, T3/T4 = locally advanced.
Treatment Decision Summary
Low Risk Localised Cancer
Active surveillance, external beam radiotherapy alone, or radical prostatectomy
Intermediate Risk Localised Cancer
Active surveillance, external beam radiotherapy alone, or radical prostatectomy
High Risk Localised Cancer
External beam radiotherapy with hormone therapy or radical prostatectomy
Locally Advanced Cancer
External beam radiotherapy with hormone therapy or radical prostatectomy
Metastatic Cancer (Newly Diagnosed)
Hormone therapy + Docetaxel (consider abiraterone or enzalutamide)
Metastatic Cancer (Hormone-Relapsed)
Abiraterone OR Enzalutamide OR Docetaxel (consider cabazitaxel or radium-223)