What do my test results mean?

Understanding your prostate cancer

Watch our animation about understanding your prostate cancer:

What do my test results mean?

Your doctor will look at your test results to find out if the cancer has spread (its stage) and how quickly it might be growing.

How far has my cancer spread?

The stage of your cancer tells you whether it has spread outside the prostate and how far it has spread. You might need scans, such as an MRI, CT or bone scan, to find out the stage of your cancer.

Depending on the results, your cancer may be treated as:

Is my cancer likely to spread?

If you have localised or locally advanced prostate cancer, your doctor may talk to you about the risk of your cancer spreading outside the prostate or coming back after treatment.

Your prostate biopsy results will show how aggressive the cancer is – in other words, how likely it is to spread outside the prostate. To work out your risk, your doctor will look at your PSA level, your Gleason score and the T stage of your cancer. These three factors will place you in one of five categories that form the Cambridge Prognostic Group (CPG). This system is used to help your doctor decide which treatment options are available to you, based on your risk.

Men in higher categories are at a higher risk of their cancer spreading and are more likely to need further treatments. Men in lower categories are most likely to have their cancer monitored by active surveillance.

The five CPG categories are based on the following:

CPG 1

  • Gleason score 6 and
  • PSA less than 10 ng/ml and
  • Stages T1–T2.

This means your cancer is likely to grow very slowly and very unlikely to spread. Your treatment options may include active surveillance, surgery and radiotherapy.

CPG 2

  • Gleason score 3 + 4 = 7
    or
  • PSA 10 to 20 ng/ml and
  • Stages T1–T2.

This means your cancer is likely to grow slowly and unlikely to spread. Your treatment options may include active surveillance, surgery and radiotherapy.

CPG 3

  • Gleason score 3 + 4 = 7 and
  • PSA 10 to 20 ng/ml and
  • Stages T1–T2
    or
  • Gleason 4 + 3 = 7 and
  • Stages T1–T2.

This means there is a medium (intermediate) risk of your cancer growing and spreading out of your prostate. Your treatment options may include surgery or radiotherapy. You may also have active surveillance if you don’t want treatment straight away or can’t have treatment.

CPG 4

One of:

  • Gleason score 8
  • PSA more than 20 ng/ml
  • Stage T3.

This means that there is a high risk of your cancer growing quickly and spreading out of your prostate. Treatment options may include surgery and radiotherapy, with or without hormone therapy.

CGP 5

Two or more of:

  • Gleason score 8
  • PSA more than 20 ng/ml
  • Stage T3
    or
  • Gleason score 9 to 10
    or
  • Stage T4.

This means that there is a high risk of your cancer growing quickly and it’s very likely to spread. Treatment options may include surgery and radiotherapy, with or without hormone therapy.

When talking to your doctor about the risk of your cancer spreading, they may refer to low, medium or high risk instead of the newer CPG system.

This older system also relies on your PSA level, Gleason score and the T stage of your cancer. It can identify which men are at high risk of their cancer spreading and the types of treatment they need. However, it isn’t as good at identifying which low and medium risk men would benefit most from active surveillance instead of other treatments.  

What happens next?

The results should help you and your doctor decide which treatments might be suitable for you. Ask your doctor or nurse to explain your test results if you don’t understand them. Or you could call our Specialist Nurses.

If you’re concerned that your doctor is using the old system, rather than the CPG system, please talk to them about it. The information on this page can help to inform them of the new system. Please remember though that both systems are only intended as guides for your doctor, and they will consider many other clinical factors when advising you about your treatment options.

Dealing with prostate cancer

Being diagnosed and living with prostate cancer can change how you feel about life. If you or your loved one is dealing with prostate cancer you may feel scared, stressed or even angry. There is no ‘right’ way to feel and everyone reacts differently.

Visit our wellbeing hub for information to help support you in looking after your emotional, mental, and physical wellbeing. If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.

References

Updated: July 2019|To be reviewed: September 2022

  • Manit Arya, Consultant Urological Surgeon, University College Hospital, London
  • Zoe Storton, Uro-oncology Clinical Nurse Specialist, Bradford Teaching Hospitals NHS Foundation Trust
  • Alastair Thomson, Consultant Clinical Oncologist, Royal Cornwall Hospitals NHS Trust
  • Karen Wilkinson, Uro-oncology Clinical Nurse Specialist, University College Hospital, London
  • Our Specialist Nurses
  • Our Volunteers.
  • Parry MG, Cowling TE, Sujenthiran A, Nossiter J, Berry B, Cathcart P, et al. Risk stratification for prostate cancer management: value of the Cambridge Prognostic Group classification for assessing treatment allocation. BMC Med. 2020 May 28;18(1):114.

  • National Institute for Clinical Excellence. Prostate Cancer: diagnosis and management. Full guideline NG131. 2021

  • Mottet N, Van den Bergh RCN, Briers E, Bourke L, Cornford P, De Santis M, et al. EAU - ESTRO - ESUR - SIOG Guidelines on Prostate Cancer. European Association of Urology; 2018.

  • National Institute for Clinical Excellence. Prostate Cancer: diagnosis and treatment. Full guideline 175. 2014.