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The five-band risk score the NHS uses for prostate cancer that has not spread. It combines the grade group, the PSA and the T stage into one number from 1 to 5, and NICE writes its treatment advice in those numbers rather than in low, intermediate and high risk.
Answer a few questions from a report and read the guideline statement that applies, quoted word for word with its source. Educational aids to prepare for an appointment, not advice.
NICE NG131 recommendation 1.2.15 asks urological cancer multidisciplinary teams to assign a risk category from its table 1 to everyone with newly diagnosed localised or locally advanced prostate cancer, and that table is the Cambridge Prognostic Groups. Group 1 is Gleason score 6 (grade group 1) and PSA under 10 micrograms per litre and stage T1 to T2. Group 2 is Gleason 3+4=7 (grade group 2) or PSA 10 to 20, with stage T1 to T2. Group 3 is Gleason 3+4=7 and PSA 10 to 20 and stage T1 to T2, or Gleason 4+3=7 (grade group 3) at stage T1 to T2. Group 4 is any one of Gleason 8 (grade group 4), PSA above 20, or stage T3. Group 5 is two or more of those three, or Gleason 9 to 10 (grade group 5), or stage T4.
The point of the five bands is that the old three-tier model, which NG131 carried until the 2021 amendment and which came from D'Amico, could not tell Gleason 3+4 from 4+3 and so put two quite different diseases in one intermediate box. The whole treatment section of NG131 is now written in CPG numbers: active surveillance is offered in CPG 1, offered as one of three equal choices in CPG 2, considered in CPG 3 for people who decline immediate radical treatment, and not offered in CPG 4 and 5 (recommendations 1.3.8 to 1.3.12); radiotherapy is combined with androgen deprivation from CPG 2 upwards, for six months, and considered for up to three years in CPG 4 and 5; isotope bone scans are not routinely offered in CPG 1 and 2. The American NCCN bands, which split intermediate risk into favourable and unfavourable and add a very high band, are a different system answering the same question, and the two do not map exactly onto each other. The Cambridge group also publishes PREDICT Prostate, a separate tool that adds the number of positive cores and the presence of intraductal or cribriform growth to produce an individual survival estimate rather than a band.
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.
Same organ: Ductal adenocarcinoma of the prostate, Localised prostate cancer, very low and low risk, 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
Showing the organ this term concerns: Prostate cancer.
Shares Percentage of Gleason pattern 4, Ductal adenocarcinoma of the prostate, Active surveillance and observation, Gleason score / Grade Group.
Shares PSA density, PSA kinetics: PSA doubling time and PSA density, Ductal adenocarcinoma of the prostate, TNM staging for prostate cancer, and what changed in the 9th edition.
Shares Active surveillance and observation, Gleason score / Grade Group, Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk.
Shares Percentage of Gleason pattern 4, Ductal adenocarcinoma of the prostate, Gleason score / Grade Group, Localised prostate cancer, intermediate risk.
Shares PSA density, Gleason score / Grade Group, PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk.
Shares Active surveillance and observation, Gleason score / Grade Group, Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk.
Shares Active surveillance and observation, PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk.
Shares Gleason score / Grade Group, PSA (prostate-specific antigen), Localised prostate cancer, intermediate risk, Localised prostate cancer, very low and low risk.