Localised prostate cancer, very low and low risk
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.
Overview
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.
State of the art
- 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.
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- ProtecT settled that low-risk disease can be watched: fifteen-year cancer mortality was around 3 percent in every arm.
Anatomy and lymph node drainage
- Peripheral zone (most cancers)
- Transition zone (BPH)
- Ducts (ductal, intraductal, neuroendocrine)
- Seminal vesicle (T3b)
- Nodes: obturator
- Nodes: internal iliac
- Nodes: external iliac
- Nodes: presacral
About three quarters of cancers arise in the peripheral zone at the back of the gland, the part a finger or a biopsy needle reaches; drainage is to the obturator and iliac nodes.
- Peripheral zone (most cancers)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
- Transition zone (BPH)
- Ducts (ductal, intraductal, neuroendocrine)
- Seminal vesicle (T3b)
- obturator
- internal iliac
- external iliac
- presacral
Same organ: Prostate cancer, Localised prostate cancer, intermediate risk, Localised prostate cancer, high and very high risk, Biochemical recurrence of prostate cancer, Metastatic hormone-sensitive prostate cancer, Non-metastatic castration-resistant prostate cancer, Metastatic castration-resistant prostate cancer, Neuroendocrine and small-cell prostate cancer
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 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.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Active surveillance with PSA every six months, MRI and repeat biopsy; treatment only on progression to Grade Group 2 or more.
Radical prostatectomy, moderately hypofractionated external beam radiotherapy, five-fraction stereotactic radiotherapy or brachytherapy, without hormone therapy.
MRI before biopsy and targeted plus systematic cores; genomic classifiers or AI pathology to refine surveillance decisions.
Subtypes & biomarkers
top- 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
- 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
How often this target appears
- 1966Gleason describes his grading system
- 1994PSA approved for early detection in the United States
- 2016ProtecT: ten-year mortality about 1 percent whether monitored or treated
- 2018PRECISION: MRI-targeted biopsy beats systematic biopsy
- 2023ProtecT fifteen-year results confirm surveillance
- 2024PACE-B: five-fraction stereotactic radiotherapy non-inferior at five years
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 11 changes by month →- 2026-09-17This recordLocalised prostate cancer, very low and low riskFacts on this page last checked
When this page itself was last checked or edited.
- 2024Trial resultPACE-BPACE-B reported
5-year biochemical or clinical failure-free 95.
- 2024MilestonePACE-BPACE-B: five-fraction stereotactic radiotherapy non-inferior at five years
A milestone in how this cancer is treated.
- 2023MilestoneProtecTProtecT fifteen-year results confirm surveillance
A milestone in how this cancer is treated.
- 2018Trial resultPRECISIONPRECISION reported
Clinically significant cancer 38% vs 26%.
- 2018MilestonePRECISIONPRECISION: MRI-targeted biopsy beats systematic biopsy
A milestone in how this cancer is treated.
What is in development for Localised prostate cancer, very low and low risk, drawn from the whole corpus: 5 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Technologies being tested · 1
Trials reported · 4
Open problems and what is being done
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.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials
Expert centres
topExpert centres
Seoul · hospital | South Korea | none recorded | 0 | 464 | 3,248 | #22 | |
Stanford · university | United States | 0 | 3,000 | 50,162 | #30 | ||
Shanghai · hospital | China | none recorded | 0 | 2,872 | 31,534 | - | |
Sydney · cancer center | Australia | none recorded | 0 | 2,222 | 33,278 | - | |
Beijing · hospital | China | none recorded | 0 | 1,784 | 18,230 | - | |
Dallas, TX · cancer center | United States | 0 | 1,744 | 19,757 | - | ||
Utrecht · cancer center | Netherlands | none recorded | 0 | 1,422 | 20,323 | - | |
Guangzhou · hospital | China | none recorded | 0 | 1,245 | 12,931 | - | |
Tianjin · cancer center | China | none recorded | 0 | 1,219 | 11,455 | - | |
Beijing · hospital | China | none recorded | 0 | 1,154 | 11,808 | - | |
Rozzano (Milan) · hospital | Italy | none recorded | 0 | 1,031 | 10,720 | - | |
Jinan · cancer center | China | none recorded | 0 | 920 | 7,804 | - | |
| United Kingdom | none recorded | 0 | 693 | 7,168 | - | ||
Chennai · cancer center | India | none recorded | 0 | 691 | 13,919 | - | |
Aarhus · hospital | Denmark | none recorded | 0 | 624 | 4,497 | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Localised prostate cancer, very low and low risk but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Localised prostate cancer, very low and low risk
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example PSA and PSA density, Gleason Grade Group 1 on biopsy, MRI PI-RADS score, Genomic classifier, Germline BRCA2 testing when family history warrants), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Very low risk, Low risk, Localised acinar adenocarcinoma, Grade Group 1.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Very low and low risk, preferred
- For my situation (very low and low risk, preferred), which of the standard options do you recommend and why?Why: Guideline options include: Active surveillance with PSA every six months, MRI and repeat biopsy; treatment only on progression to Grade Group 2 or more.
- How do the results of ProtecT apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Low risk, men who prefer treatment
- For my situation (low risk, men who prefer treatment), which of the standard options do you recommend and why?Why: Guideline options include: Radical prostatectomy, moderately hypofractionated external beam radiotherapy, five-fraction stereotactic radiotherapy or brachytherapy, without hormone therapy.
- How do the results of CHHiP and PACE-B apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Diagnosis
- For my situation (diagnosis), which of the standard options do you recommend and why?Why: Guideline options include: MRI before biopsy and targeted plus systematic cores; genomic classifiers or AI pathology to refine surveillance decisions.
- Am I a candidate for Decipher Prostate, ArteraAI Prostate, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of PRECISION apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Any stage
- Are there clinical trials I could join, for example of ArteraAI Prostate, Decipher Prostate, Multiparametric prostate MRI (PI-RADS)?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Which Grade Group 1 cancers will upgrade, and whether Grade Group 1 should be called cancer at all”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “How often to repeat biopsy on surveillance and whether MRI alone can replace it”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Localised prostate cancer, very low and low risk, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
9drugs
2companies
2terms
2trials
4Latest papers
topQuery for this cancer: (TITLE:"Localised prostate cancer, very low and low risk" OR ABSTRACT:"Localised prostate cancer, very low and low risk" OR TITLE:"Low-risk prostate cancer" OR ABSTRACT:"Low-risk prostate cancer" OR TITLE:"Very low risk prostate cancer" OR ABSTRACT:"Very low risk prostate cancer" OR TITLE:"Grade Group 1 prostate cancer" OR ABSTRACT:"Grade Group 1 prostate cancer" OR TITLE:"NCCN very low and low risk" OR ABSTRACT:"NCCN very low and low risk") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Localised prostate cancer, very low and low risk, not a curated reading list.
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