# Localised prostate cancer, very low and low risk

Source: https://onco.cc/cancers/prostate-low-risk/  
OnCo record `prostate-low-risk` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Low-risk prostate cancer is Grade Group 1 disease confined to the gland with a PSA under 10. It grows so slowly that watching it closely is the recommended first choice, and most men who choose surveillance never need treatment.

## Summary

Very low and low risk localised prostate cancer is defined by the NCCN as clinical stage T1 to T2a, Grade Group 1 (Gleason 3+3) and PSA below 10 ng/mL; very low risk adds fewer than three positive cores, under half of any core involved and a PSA density below 0.15. It is found by PSA testing followed by MRI and targeted biopsy, the pathway PRECISION showed finds more dangerous cancers with fewer needles. Active surveillance, with PSA every six months, repeat MRI and repeat biopsy, is the preferred option: ProtecT followed 1,643 men for fifteen years and found prostate cancer deaths of around 3 percent in every arm, whether monitored, operated on or irradiated. Men who prefer or later need treatment have radical prostatectomy, external beam radiotherapy (now moderately hypofractionated after CHHiP, or five fractions of stereotactic radiotherapy after PACE-B) or brachytherapy, without hormone therapy. Genomic classifiers and AI pathology can refine who is safe to watch, and germline testing is offered when the family history suggests it.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: Low-risk prostate cancer; Very low risk prostate cancer; Grade Group 1 prostate cancer; NCCN very low and low risk
- Tags: subtype-page
- Group: genitourinary
- Burden: Roughly a third of prostate cancers diagnosed in screened populations; fewer than one in a hundred men with low-risk disease die of it within fifteen years whether monitored or treated.
- Subtypes: Very low risk (T1c, Grade Group 1, PSA under 10, fewer than 3 cores, PSA density under 0.15); Low risk (T1 to T2a, Grade Group 1, PSA under 10); Localised acinar adenocarcinoma, Grade Group 1
- Biomarkers: PSA and PSA density; Gleason Grade Group 1 on biopsy; MRI PI-RADS score; Genomic classifier (Decipher, Oncotype DX GPS, Prolaris); Germline BRCA2 testing when family history warrants

## Standard of care

- Very low and low risk, preferred: Active surveillance with PSA every six months, MRI and repeat biopsy; treatment only on progression to Grade Group 2 or more. ([Active surveillance](https://onco.cc/technologies/active-surveillance/), [ProtecT](https://onco.cc/trials/protect/), [Multiparametric prostate MRI (PI-RADS)](https://onco.cc/technologies/mp-mri/), [PSA (prostate-specific antigen)](https://onco.cc/terms/psa/), [Gleason score / Grade Group](https://onco.cc/terms/gleason-grade-group/))
- Low risk, men who prefer treatment: Radical prostatectomy, moderately hypofractionated external beam radiotherapy, five-fraction stereotactic radiotherapy or brachytherapy, without hormone therapy. ([Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/), [Brachytherapy](https://onco.cc/technologies/brachytherapy/), [CHHiP](https://onco.cc/trials/chhip/), [PACE-B](https://onco.cc/trials/pace-b/))
- Diagnosis: MRI before biopsy and targeted plus systematic cores; genomic classifiers or AI pathology to refine surveillance decisions. ([Multiparametric prostate MRI (PI-RADS)](https://onco.cc/technologies/mp-mri/), [PRECISION](https://onco.cc/trials/precision-mri/), [Decipher Prostate](https://onco.cc/drugs/decipher-prostate/), [ArteraAI Prostate](https://onco.cc/drugs/artera-ai-prostate/))

## State of the art

- ProtecT settled that low-risk disease can be watched: fifteen-year cancer mortality was around 3 percent in every arm.
- MRI-first diagnosis finds fewer of these indolent cancers and more of the dangerous ones.
- Surveillance uptake for low-risk disease has risen from a fifth to more than half of eligible men in a decade.

## Open problems

- Which Grade Group 1 cancers will upgrade, and whether Grade Group 1 should be called cancer at all.
- How often to repeat biopsy on surveillance and whether MRI alone can replace it.
- Overdiagnosis by PSA screening against the deaths screening prevents.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Active_surveillance_of_prostate_cancer
- Wikipedia: https://en.wikipedia.org/wiki/Active_surveillance_of_prostate_cancer
- NCCN Guidelines: Prostate Cancer: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459

## Connected records

- terms: [Gleason score / Grade Group](https://onco.cc/terms/gleason-grade-group/), [PSA (prostate-specific antigen)](https://onco.cc/terms/psa/)
- trials: [CHHiP](https://onco.cc/trials/chhip/), [PACE-B](https://onco.cc/trials/pace-b/), [PRECISION](https://onco.cc/trials/precision-mri/), [ProtecT](https://onco.cc/trials/protect/)
- drugs: [ArteraAI Prostate](https://onco.cc/drugs/artera-ai-prostate/), [Decipher Prostate](https://onco.cc/drugs/decipher-prostate/)
- technologies: [Active surveillance](https://onco.cc/technologies/active-surveillance/), [Brachytherapy](https://onco.cc/technologies/brachytherapy/), [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [Multiparametric prostate MRI (PI-RADS)](https://onco.cc/technologies/mp-mri/), [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/)
- cancers: [Prostate cancer](https://onco.cc/cancers/prostate/)

---
JSON: https://onco.cc/api/v1/entities/prostate-low-risk.json