What are the NCCN prostate cancer risk groups?

For clinically localized disease (N0, M0) NCCN uses low, intermediate (split into favorable and unfavorable), high and very high risk. Low: cT1–cT2a, Grade Group 1 and PSA 20. Very high: cT3b–cT4, primary Gleason pattern 5, 2–3 high-risk features, or more than 4 cores with Grade Group 4–5.

Did NCCN remove the very-low-risk group?

Yes. The NCCN Guidelines Insights for Prostate Cancer Version 5.2026 (JNCCN, May 2026) list the elimination of the very-low-risk group among the 2026 updates. Patients who met the old very-low criteria are now low risk. Earlier versions defined very low as cT1c, Grade Group 1, PSA < 10, fewer than 3 positive cores, ≤ 50% cancer in each core and PSA density < 0.15 ng/mL/g. Switch the guideline to 2024–2025 to apply that split.

How are favorable and unfavorable intermediate risk distinguished?

Favorable intermediate needs all of: exactly 1 intermediate risk factor, Grade Group 1 or 2, and fewer than 50% of biopsy cores positive. Unfavorable intermediate is any of: 2 or 3 intermediate risk factors, Grade Group 3, or 50% or more of biopsy cores positive. Without core counts a single-factor case cannot be confirmed as favorable, so the tool flags it as incomplete.

How do I convert a Gleason score to a Grade Group?

Gleason 3+3 = Grade Group 1; 3+4 = GG 2; 4+3 = GG 3; 4+4, 3+5 or 5+3 = GG 4; 4+5, 5+4 or 5+5 = GG 5. "Primary pattern 5" means the most common pattern is 5 (5+3, 5+4, 5+5), which is a very-high-risk feature on its own.

How is PSA density calculated?

PSA density = PSA (ng/mL) ÷ prostate volume (mL, or grams; 1 mL ≈ 1 g) from MRI or transrectal ultrasound. A PSA of 5.2 with a 40 mL gland gives 0.13 ng/mL/g. Under the 2024–2025 criteria a density below 0.15 was required for very low risk.

Is this medical advice?

No. It is an educational summary of published guideline criteria. Risk grouping also depends on pathology review, MRI, life expectancy, genomic tests and nodal or metastatic staging, which this tool does not assess. Treatment decisions belong to you and your care team, using the current guideline at nccn.org.

Does this tool store or transmit health information?

No. All calculations run in your browser. Nothing you enter is logged, stored or sent to a server.

NCCN Prostate Cancer Risk Stratification Calculator

NCCN groups localized prostate cancer by T stage, Grade Group and PSA. Low: cT1–cT2a, GG 1 and PSA < 10. Intermediate: any of cT2b–c, GG 2–3 or PSA 10–20. It is favorable with 1 factor, GG 1–2 and < 50% positive cores; otherwise unfavorable. High: exactly one of cT3a, GG 4–5 or PSA > 20. Very high: cT3b–T4, primary pattern 5, 2–3 high-risk features or > 4 cores of GG 4–5. The 2026 guideline removed the very-low group. Educational only, not medical advice.

Patient Clinical & Pathology Parameters

Provide baseline staging, serology, and biopsy metrics. Educational tool, not medical advice.

Guideline Version

Gleason Score Helper (fills Grade Group)

Primary pattern

Secondary pattern

PSA Level (ng/mL) *

Clinical T Stage *

Gleason Grade Group *

Primary Gleason Pattern 5

Systematic Biopsy Core Quantification

Total Cores Examined

Positive Cores

Cores with GG 4 or 5

Very Low Risk Elements (2024–2025 criteria)

Prostate Volume (mL)

Max % Cancer in Any Single Core

PSA Density (ng/mL/g)

Unit Relationships & Metric Definitions

Percent Positive Cores: Calculated as (Positive Cores / Total Cores) × 100%. A value ≥ 50% constitutes an unfavorable intermediate-risk feature under NCCN guidelines.

Max Core Cancer Involvement: The highest fraction of malignant involvement in any individual core biopsy. ≤ 50% was required for Very Low (2024–2025).

PSA Density (PSAD): Calculated as Serum PSA (ng/mL) divided by Prostate Volume (cc or g) determined by transrectal ultrasound or MRI. PSAD < 0.15 ng/mL/g was required for Very Low risk (2024–2025). If you enter the volume and leave density blank, it is calculated for you.

Enter patient parameters and click "Evaluate NCCN Risk Tier".

NCCN Localized Risk Group Reference

NCCN 2026 (Insights v5.2026)

Risk Group	T Stage	Grade Group	PSA (ng/mL)	Additional Criteria
Very Low 2024–2025 only; merged into Low in 2026	cT1c	GG 1	< 10	<3 pos cores, ≤50% cancer/core, PSAD <0.15
Low	cT1–cT2a	GG 1	< 10	2026: all such patients. 2024–2025: those not meeting Very Low
Fav. Intermediate	cT2b–cT2c *	GG 1–2 *	10–20 *	Exactly 1 IR factor, GG 1–2, and <50% positive cores
Unfav. Intermediate	cT2b–cT2c *	GG 2–3 *	10–20 *	GG 3 OR ≥2 IR factors OR ≥50% positive cores
High	cT3a *	GG 4–5 *	> 20 *	Exactly 1 high-risk factor; no very-high features
Very High	cT3b–cT4	Primary 5	Any	≥2 high factors, or >4 cores with GG 4/5

* Denotes an independent risk factor within that group. Note: MRI targeted cores require pathologist clinical synthesis.

Not Medical Advice — Guideline Scope

This calculator is strictly an educational screening aid based on published NCCN and AUA/ASTRO localized prostate cancer risk definitions. It does not replace individualized clinical, histopathologic, and multi-parametric MRI assessment by a multidisciplinary oncology care team.

The tool does not estimate life expectancy, evaluate nodal or metastatic staging (cN/cM), or mandate therapeutic interventions.

References: NCCN Prostate Cancer guideline and AUA/ASTRO localized prostate cancer guideline. Verify the current guideline version with the treating team.

Version note: NCCN Guidelines Insights: Prostate Cancer, Version 5.2026 (J Natl Compr Canc Netw, May 2026; doi:10.6004/jnccn.2026.0023) reports the elimination of the very-low-risk group. The intermediate, high and very-high definitions used here match the 2024–2025 versions. NCCN updates the guideline several times a year, so check nccn.org for the latest version.

Summary

This educational tool applies the NCCN Clinical Practice Guidelines in Oncology initial risk stratification for clinically localized prostate cancer. It uses pre-treatment PSA, Gleason pattern or Grade Group, biopsy core counts, primary pattern 5 status, clinical T stage and PSA density. The default follows the 2026 guideline: NCCN Guidelines Insights, Prostate Cancer Version 5.2026 (JNCCN, May 2026), which removed the very-low-risk group. A switch applies the 2024–2025 criteria that still split very low from low. Everything runs in your browser and nothing is stored or sent. It is not medical advice and does not replace your care team.

How it works

Choose the guideline: NCCN 2026 (no very-low group) or 2024–2025 (very low split from low).
Enter the pre-treatment PSA (ng/mL) and the clinical T stage from the exam and imaging.
Pick the Gleason primary and secondary pattern to fill in the Grade Group and primary pattern 5 automatically, or select the Grade Group directly.
Enter total and positive biopsy cores and the number of cores with Grade Group 4–5. The tool shows the percent of positive cores.
For the 2024–2025 very-low check, also enter the maximum % cancer in any core and PSA density, or the prostate volume to compute PSA density = PSA ÷ volume.
Click Evaluate to see the risk group, the criteria that triggered it, missing data, and the matching row in the reference table.

Use cases

Learn how NCCN assigns low, intermediate, high and very-high risk before a urology or oncology visit.
See whether intermediate-risk disease counts as favorable or unfavorable from biopsy core numbers.
Check the very-high-risk triggers: cT3b–cT4, primary pattern 5, two or more high-risk features, or more than 4 high-grade cores.
Compare the 2026 groups with the older very-low/low split used in many papers and surveillance protocols.
Compute PSA density from PSA and MRI or ultrasound prostate volume.

Frequently Asked Questions

Last updated: 2026-10-10 · Reviewed by Nham Vu