What Are the Different Types of Prostate Cancer?

Prostate cancer isn’t just one illness — that’s because not all prostate cancers behave the same way. There are several types of prostate cancer. Some prostate cancers grow slowly, don’t  travel outside of the prostate, and never cause any symptoms. Other types of prostate cancer grow quickly and spread to other parts of the body, causing more serious illness. 

Let’s take a look at the most common types of prostate cancer and what it can mean for your treatment options. 

What are the different types of prostate cancer?

There are several types of cancer that grow in the prostate. The different types of prostate cancer include:

• Prostate adenocarcinoma

• Sarcoma

• Transitional cell carcinoma

• Neuroendocrine

• Small cell carcinoma

The last four types of cancers are very rare. They grow from different types of cells in and around the prostate gland. These types of cancers make up less than 5% of all prostate cancers.

What’s the most common type of prostate cancer?

The most common type of prostate cancer is prostate adenocarcinoma. This is what most people think of when they hear about prostate cancer. Prostate adenocarcinoma forms from prostate cells. About 95% of all cases of prostate cancer are prostate adenocarcinomas. 

But one important thing to understand about prostate adenocarcinomas is that not all of them behave the same way. Some types are very slow growing while others are much more aggressive. The different types of prostate adenocarcinoma include cancer that is: 

• Low risk (and very low risk) 

• Intermediate risk (favorable and unfavorable)

• High risk (and very high risk)  

The risk group correlates to how likely it is that your cancer may spread and cause serious illness.  

There are several pieces of information that help determine whether prostate cancer is low, intermediate, or high risk:

• The prostate-specific antigen (PSA) level

• How big the tumor feels during a digital rectal exam 

• The number of core samples from the prostate biopsy that have cancer cells

• The Gleason score and grade group (this describes what the cancer cells look like under a microscope)

• The number of lymph nodes that have cancer cells and if the cancer has spread from the prostate to other areas (also called “metastasized”)

Low-risk prostate cancer

Low-risk and very low-risk prostate cancers are the least likely to spread to other parts of the body. They grow very slowly. Some people can live for decades with these types of prostate cancer and never develop any symptoms or health problems from the cancer. These types of cancer may not need aggressive treatment like radiation or surgery. They’re also the most common type of prostate adenocarcinoma. 

Your cancer is considered very low risk (access to the linked article requires a no-cost registration) if:

• Your tumor is small and can’t be felt on a digital rectal exam.

• The cancer cells haven’t spread beyond the prostate or to the lymph nodes.

• Your grade group is 1 (or your Gleason score is 6 or less).

• Your PSA level is less than 10. 

• Your PSA density is less than 0.15. 

• Fewer than three of your biopsy cores had cancer cells in them.

Your cancer is considered low risk if:

• Your tumor can only be felt on one side of the prostate or your tumor can’t be felt at all.

• Cancer cells haven’t spread beyond your prostate or to your lymph nodes.

• Your grade group is 1 (or your Gleason score is 6 or less).

• Your PSA level is less than 10. 

Intermediate-risk prostate cancer

Intermediate-risk prostate cancers are more likely to spread and cause health problems than low-risk prostate cancer. They can sometimes be felt on a digital rectal exam but haven’t spread beyond the prostate. 

Experts divide intermediate-risk prostate cancers into two groups: favorable intermediate risk and unfavorable intermediate risk. These subgroups describe how cancer is likely to behave long term. The difference often comes down to the Gleason score and prostate biopsy results. 

A favorable intermediate-risk prostate cancer means:

• The PSA level is less than 20.

• The cancer has a grade group of 1 or 2 and less than half of the prostate biopsy samples showed cancer cells.

An unfavorable intermediate-risk prostate cancer means:

• The PSA level is between 10 and 20.

• The cancer has a grade group of 2 and more than half of the prostate biopsy samples showed cancer cells or the cancer has a grade group of 3.

High-risk prostate cancer

High-risk prostate cancers can grow and spread quickly. They can lead to serious health problems and death. People with high-risk prostate cancer need to start treatment more quickly. 

People with high-risk prostate cancers have higher PSA levels, and Gleason scores and grade groups. In some cases, the cancer may have already spread to other parts of the body near the prostate. This type of cancer is very aggressive, but it’s the least common type of prostate adenocarcinoma. 

Why does the type of prostate cancer you have matter?

The type of prostate cancer you have will determine what kind of treatment you need. People with slow-growing prostate cancers don’t always need aggressive treatment. Studies show that people with these types of prostate cancers actually end up dying for another reason, like old age or another illness. Some of these people never even knew they had prostate cancer in the first place. 

Since prostate cancer treatment comes with its own risks and side effects, it can make sense to avoid the risks of treatment. People with very low-risk and low-risk prostate cancers can opt for active surveillance instead of more aggressive treatment like surgery or radiation. 

Active surveillance means getting regular exams, prostate biopsies, prostate MRIs, and other testing to make sure prostate cancer hasn’t progressed. Studies show active surveillance is safe and effective. People can often delay more aggressive treatment for years by using active surveillance.

If you have a higher-risk prostate cancer, you may need treatment right away. But there are many treatment options for prostate cancer. Knowing your risk group helps you and your healthcare team determine the best treatment option(s). 

Can the type of prostate cancer you have change over time?

Maybe. 

Very low-risk and low-risk prostate cancer is less likely to change and become more aggressive. But intermediate- and high-risk prostate cancers can become more aggressive over time. It’s important to discuss this risk with your healthcare team. This will help you create a care plan that balances the risks of treatment with the risks of your cancer spreading and causing more serious health problems.

If you’ve been diagnosed with prostate cancer, there are things you can do that may lower the risk of your cancer becoming more aggressive. These include:

• Eating a plant-based diet 

• Getting regular exercise

• Not smoking

• Drinking alcohol in moderation or avoiding it completely

Why trust our experts?

Written by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Brandon R. Mancini, MD, MBA, FACRO

Brandon R. Mancini, MD, MBA, FACRO, serves as medical director at BAMF Health in Grand Rapids, Michigan in the emerging field of theranostics. His primary clinical focus is on the treatment of people with metastatic prostate and neuroendocrine cancers.

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