Prostate Cancer Very High Risk

What Very High Risk Means

Stage T4 OR PSA >40 OR Gleason 9–10 with any T/PSA OR Grade Group 5 with PSA 20–40

Treatment Approach for Very High Risk

Aggressive systemic therapy. EBRT – 36+ months ADT with or without docetaxel or novel hormonal agents. Consider intensification with Lu-177 PSMA after progression.

Survival Rates and Prognosis

The 5-year survival rate for prostate cancer at Very High Risk is approximately 70%–85% (10-yr: 55%–75%). Survival rates are statistical averages drawn from large patient populations and may not reflect your individual outcome. Factors that influence your specific prognosis include your age, overall health, tumour biology, and how well the cancer responds to treatment.

Important: These numbers are drawn from historical data. Newer treatments available today may improve outcomes beyond what published statistics show. Discuss your individual prognosis with your oncologist.

How Other Stages Compare

Stage	5-Year Survival	Treatment
Very Low Risk	99%+ (10-yr: 98%+)	Active surveillance preferred. Annual PSA, DRE, repeat biopsy in 1–2…
Low Risk	98%+ (10-yr: 95%)	Active surveillance or definitive therapy (RARP or radiation). Discuss 10-year…
Intermediate Risk	95% (10-yr: 88%–92%)	Definitive therapy: RARP with or without pelvic lymph node dissection, or EBRT…
High Risk	88%–93% (10-yr: 75%–85%)	Definitive therapy + ADT. EBRT – 24–36 months ADT preferred if fit….
Metastatic Hormone-Sensitive (mHSPC)	40%–60% (10-yr: 10%–25%)	Upfront ADT + docetaxel (STAMPEDE/CHAARTED trials showed docetaxel improves…
Metastatic Castration-Resistant (mCRPC)	15%–30% (10-yr: <10%)	Sequence of hormone therapies (abiraterone, enzalutamide, apalutamide) or…