Prostate cancer (PCa) is the most common non-skin cancer in men. Although the word “cancer” strikes fear, when PCa is caught early at the lowest risk level, it is highly treatable. In fact, for low-risk PCa the 10-year success rates are nearly 100%. The key is early diagnosis. Thus, if PCa is found when it’s Grade Group 1, several treatment options are open, and long-term success rates are high. Continue reading to learn more about Grade Group 1 (GG1).

Diagnosing PCa

Detecting PCa early is not easy because in the beginning there are no symptoms. However, a simple blood test picks up a biomarker called prostate specific antigen (PSA). When PSA levels are higher than normal, it is a non-specific warning sign that something is bothering the prostate gland—but it may not be PCa. There are two basic ways to rule out PCa before having a biopsy:

1. Additional blood or urine genomic tests for PCa-specific biomarkers. Such tests analyze the presence of gene variants or other molecular markers that characterize higher risk PCa
2. Multiparametric MRI (mpMRI) with PI-RADS scores help identify lesions that are suspicious for clinically significant PCa that may require more aggressive treatment.

Each of these two added steps can supply needed information prior to a biopsy, and they are often used in combination. If PCa is ruled out, it’s generally safe to skip a biopsy, and re-check PSA 6-12 months.

On the other hand, if either or both of these steps reveal further suspicion of PCa, a biopsy is necessary for definitive diagnosis. This is the only way to see if PCa cells are present. It also allows use of the Gleason score system to assign a risk level. However, this two-number system has often confused patients, so a new Grade Group system was created, from 1 (low risk) to 5 (high risk):

Risk Level	Grade Group	2-number Gleason equivalent
Low	Grade Group 1	Gleason score < 3 + 3 = 6
Intermediate favorable	Grade Group 2	Gleason score 3 + 4 = 7
Intermediate unfavorable	Grade Group 3	Gleason score 4 + 3 = 7
High	Grade Group 4	Gleason score 8
High	Grade Group 5	Gleason score 9-10

Grade Group 1 (GG1) allows the most options

Being diagnosed with GG1 is a kind of bad news/good news situation. The bad news is, you have PCa but the good news is, it’s Grade Group 1. In fact, there’s much debate as to whether it should even be called cancer. Many experts believe that GG1 PCa does not always act like we expect cancer to behave. GG1, or Gleason score 3+3 = 6 appears to be indolent, or lazy. They don’t seem to become more aggressive over time, nor does the tumor appear to enlarge.^[i] This opens up two strategies for managing GGA PCa:

1. The first is Active Surveillance (AS). This means proactively keeping an eye on GG1 PCa while holding off on immediate treatment. Monitoring must be strictly adhered to in order to avoid missing a treatment window if there’s an uptick in PCa activity. Surveillance involves PSA tests and mpMRI at regular intervals prescribed by your doctor. Also, adopting a very healthy lifestyle including plant-forward diet and vigorous exercise may help keep PCa from progressing.^[ii]
2. The second option, Focal Therapy, is for patients who aren’t comfortable with AS because they don’t like the idea of cancer living in their body—but they don’t want the side effect risks of immediate surgery or radiation. As a middle ground between AS and whole gland treatment, Focal Therapy consists of a minimally invasive outpatient treatment to destroy the targeted lesion while sparing healthy prostate tissue. Without surgery or radiation, it defeats the cancer, has very low side effect risks, and doesn’t close off any future treatments. The Sperling Prostate Center offers expert MRI-guided Focal Laser Ablation and TULSA.

After any treatment for PCa, PSA and MRI monitoring continues into the future to detect any possible recurrence. But unlike AS, Focal Therapy eases worry over monitoring because the tumor is gone.

A word of caution about GG1

A recently published paper on GG1 points out the need for meticulous diagnosis of GG1 PCa. About 1 out of 6 prostatectomy patients diagnosed with GG1 were found to have higher risk disease at the time of surgery.^[iii] Standard TRUS biopsies are known to have a margin of error (underdiagnose significant PCa) which may account for some of these cases. Even fusion-guided biopsy can miss higher risk PCa due to “radiologist misinterpretation, poor targeting during MRI-targeted biopsy, or lesion MRI-invisibility.”^[iv]

Thanks to the meticulous diagnostic workup protocol at the Sperling Prostate Center, Dr. Sperling and his team have a high degree of confidence in evaluating GG1 tumors for Focal Therapy. In particular, our real-time in-bore MRI-guided targeted biopsy offers better accuracy than both TRUS and fusion-guided biopsy because with real-time imaging, the core of the index lesion visible on MR is sampled with a few needles. This is where the riskiest PCa cells are most likely to be present.^[v] A recent (Aug 2025) study found that the better accuracy of in-bore targeted biopsy may reduce overtreatment of GG1 disease.^[vi]

Patients whose GG1 PCa is detected early have reason to feel consoled. Those who qualify for a focal approach can hold off on having a more aggressive whole gland treatment. While there is not yet long-term data for Focal Therapy, mid-term data points to comparable cancer control to surgery or radiation.

The Sperling Prostate Center recommends that all men have an annual PSA test for the best possible chance to catch PCa when it is Grade Group 1. Although controversy over the true nature of GG1 PCa will undoubtedly continue for the foreseeable future, there is consolation knowing that it gives the choice of holding off on immediate whole gland treatment through AS or Focal Therapy.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Bedi N, Reddy D, Ahmed HU. Targeting the cancer lesion, not the whole prostate. Transl Androl Urol. 2020 Jun;9(3):1518-1525.
[ii] Ornish D, Magbanua MJ, Weidner G, Weinberg V et al. Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Natl Acad Sci U S A. 2008 Jun 17;105(24):8369-74.
[iii] Patel NA, Barocas DA, Lin DW, et al. Grade Group 1 Prostate Cancer Outcome by Biopsy Grade and Risk Group. JAMA Oncol. Published online July 31, 2025. doi:10.1001/jamaoncol.2025.2304
[iv] Williams C, Ahdoot M, Daneshvar MA, Hague C, Wilbur AR et al. Why Does Magnetic Resonance Imaging-Targeted Biopsy Miss Clinically Significant Cancer? J Urol. 2022 Jan;207(1):95-107. 
[v] Bedi N et al. Ibid.
[vi] Petov V, Badyan K, Gredzhev V, Khalidis E et al. Software mpMR/US fusion, cognitive, and in-bore biopsy: a comparative analysis of prostate cancer detection. Int Urol Nephrol. 2025 Aug 20.