Determining Your Prostate Cancer Risk Level

Early prostate cancer usually does not cause symptoms. However, untreated prostate cancer can cause the following symptoms:

  • Frequent, painful or difficult urination
  • Painful or difficult erection
  • Blood in the urine or semen
  • Persistent pain or stiffness in the lower back, hips or upper thighs  

If you have these symptoms, you should see your doctor right away. Most prostate cancers are found in the early stages, before symptoms appear, during a routine exam or through the following screening tests.  

  • PSA Blood Test:  This test detects a protein, called prostate-specific antigen (PSA), made by the prostate gland. Increased PSA levels may suggest prostate cancer.  
  • DRE Physical Exam:  In the digital rectal exam (DRE), a doctor uses his or her finger to feel your prostate gland through your rectum, checking for bumps or hard areas that might indicate cancer is present.  

To confirm a prostate cancer diagnosis, doctors must perform a biopsy. In a biopsy, the doctor uses needles to remove tiny tissue samples from the prostate that are then sent to a laboratory and examined under a microscope.  

Gleason Score:  If your biopsy shows prostate cancer, the pathologist gives the cancer a grade from 1 to 5 indicating how fast your tumor is likely to grow or spread. Because your cancer may contain areas with different grades, the pathologist will identify the two most commonly occurring grades and add them together to come up with your Gleason Score. This is an important number to know.  


Gleason Score Aggressiveness

6 or less

Less aggressive, likely to grow more slowly


Moderately aggressive, likely to grow but may not spread quickly


Highly aggressive, likely to grow faster and spread

Tumor T Stage: Another important measure of your cancer is the tumor, or T, stage. This number refers to the size of the tumor and whether the cancer has spread.  



What It Means

Stage 1 – T1 Tumor

Cancer is found only in the prostate. It might be too small to feel during a DRE and is usually detected by an elevated PSA blood test.

Stage 2 – T2 Tumor

The tumor is larger than a Stage 1 tumor and it is still confined to the prostate but can be felt by DRE.

Stage 3 – T3 Tumor

The cancer has spread beyond the prostate but remains within the pelvic area, such as the seminal vesicles. .

Stage 4 – T4 Tumor

The cancer has spread outside the prostate and pelvic area to locations such as the lymph nodes, bladder, rectum and bones.

Imaging:  Your doctor may also decide to order X-rays or imaging tests, such as a bone scan, to see if your cancer has spread beyond your prostate.  

Know Your Risk Group:  Your doctor will use measures including your PSA level, Gleason score and tumor T stage to determine if your cancer is low, medium or high risk. Talk to your doctor to see what risk group you fit into, since that will help you and your doctor decide what to do next. These steps may include additional tests, such as the Oncotype DX prostate cancer test, as well as potential treatment options.