High risk prostate cancer means that tumors may be at risk of spreading beyond the prostate or have already done so.

Prostate cancers are divided into one of three risk groups: low, intermediate, and high risk. Each of these risk groups is based on data collected from prostate specific antigen (PSA) blood tests and prostate tumor biopsies.

While considered potentially more aggressive, high risk prostate cancer is still considered a localized type of cancer, which means tumors have spread to nearby tissues but not to lymph nodes or other distant areas.

Learn more about this prostate cancer risk group, including testing, symptoms, and treatment options to further discuss with a doctor.

Language matters

You’ll notice that “male” and “men” are used to share stats and other data points in this article.

Although we typically use more inclusive language, specificity is key when reporting on research participants and clinical findings.

Unfortunately, the studies and surveys referenced in this article didn’t report data on, or include, participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

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When assigning a risk group for prostate cancer, doctors use a diagnostic tool called a Gleason scale. This involves taking a biopsy of the suspected tumor and then grading it to estimate how quickly it might spread. The higher the Gleason score, the more likely the cancer may spread.

Having high risk prostate cancer means that you may have a Gleason score of 8 to 10. Another qualifying factor is a PSA level higher than 20.

High risk prostate cancer also means that tumor cells have started growing outside of the prostate area. This is also diagnosed as T3a prostate cancer, in which cancer has spread outside of the prostate but not to the seminal vesicles.

A subtype of high risk prostate cancer is known as “very high risk.” This means that the cancer may possibly spread out of the prostate to the seminal vesicles, bladder, or rectum.

A doctor may also classify certain prostate cancers as very high risk if they exhibit certain traits that suggest the tumor may keep growing or might come back after treatment. These include multiple biopsies that come back with Gleason scores between 8 and 10.

Having high risk prostate cancer means that the tumor has spread outside of the prostate to nearby tissues only, but it also has the potential to spread to other areas. It also falls under stage 3.

A PSA level higher than 20, a key diagnostic factor for high risk prostate cancer, is also typically found in stage 3A prostate cancers. T scores of T3a are also indicate stage 3 prostate cancer.

While the staging of prostate cancer is highly individual and based on a number of factors, here’s a look at some of the key differences found within stage 3:

  • Stage 3A: Gleason score of 8 or less and a PSA level over 20; cancer has not yet spread beyond the prostate
  • Stage 3B: Gleason score of 8 or less and any PSA level; cancer has spread outside of prostate in this stage
  • Stage 3C: Gleason score of 9 or 10 and any PSA level; the cancer may have spread to nearby tissues

Symptoms of localized prostate cancer may be similar to those of benign prostatic hyperplasia (BPH), so it’s important to see a doctor if you’re experiencing any of the following:

  • trouble with urinating
  • difficulty emptying your bladder completely
  • weak flow of urine
  • frequent urination
  • frequently waking up at night to urinate

High risk prostate cancer may eventually spread without treatment. Symptoms of advanced prostate cancer that has spread may include:

  • blood in urine
  • back pain
  • hip or pelvic pain
  • dizziness
  • fatigue
  • shortness of breath
  • anemia (lack of healthy red blood cells to carry oxygen to your body’s tissues)
  • rapid heart rate

Localized forms of prostate cancer like high risk groups are primarily diagnosed by using PSA blood testing, a biopsy of the tumor, and a digital rectal exam (DRE).

Additionally, a doctor may consider other tests to better predict the chances that high risk prostate cancer may spread. These include genetic and molecular laboratory tests that assess cells taken from a biopsy sample.

In some cases, prostate cancer can be cured. While low risk and intermediate risk prostate cancer may involve “watchful waiting,” a doctor may recommend a combination of treatment methods for high risk cases to stop tumors from spreading.

High risk prostate cancer usually falls under stage 3 cancer. Due to the complexities of this stage, you may undergo a combination of treatments, such as:

Overall, prostate cancer isn’t usually deadly. However, having high risk forms means that there’s a greater chance the cancer could spread and become more difficult to treat.

The average 5-year survival rate for prostate cancers was 97% based on data collected between 2012 and 2018. For localized and regional prostate cancers seen in earlier stages, the 5-year survival was at least 99%, while prostate cancer that spread had a 32% 5-year survival rate.

Such data suggests that people with prostate cancer have an overall positive outlook when the cancer is detected and treated early.

What is a 5-year survival rate?

Health professionals often use the 5-year survival rate as a measure of the outlook for a person with a disease. This measure refers to the percentage of people with the disease that are still alive at least 5 years after receiving their diagnosis.

Another commonly used term is “5-year relative survival rate.” This is a measure of how many people with the disease are alive 5 years later compared with people without the disease.

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Prostate cancer is extremely common in older people born male, with an estimated 1 in 8 men being affected at some point in their lifetimes. While most people survive, you may have specific questions regarding high risk groups and whether these affect your treatment options.

What does high risk cancer mean?

Having a high risk form of cancer means that there’s a chance that cancerous cells may spread from the initial site (in this case, the prostate) to other more distant sites like lymph nodes and organs.

How fast does high risk prostate cancer spread?

In general, prostate cancer is a slow-growing cancer that may take several years to develop, which is a longer amount of time compared with other cancers. It may also take longer than this for the cancer to spread, as in the case of high risk groups.

However, a doctor will make treatment recommendations based on your individual test results to determine the risk of prostate cancer growing and spreading.

What is the best treatment for high risk prostate cancer?

There’s no single best treatment for high risk prostate cancer. Instead, a doctor will likely recommend a combination of therapies based on how far the cancer has spread outside of prostate tissues.

High risk prostate cancer is a type of localized cancer, which means tumors have spread to nearby tissues but not to lymph nodes or other distant areas.

While prostate cancers are generally slow-growing and sometimes require a wait-and-see approach, a doctor may recommend treating high risk groups to prevent the cancer from spreading.

Speak with a doctor about the chances that your cancer might spread and what the best treatment options may be for your individual case.