Grade Group 1 (Gleason 6) prostate cancer is now recognized as having virtually zero metastatic potential. For the vast majority of these patients, Active Surveillance is the preferred management strategy to avoid the morbidity of surgery or radiation.

The most important clinical utility of this system is separating the two "Gleason 7" patterns. Grade Group 3 (4+3) has a significantly higher risk of biochemical recurrence and metastasis compared to Grade Group 2 (3+4), often justifying more aggressive adjuvant strategies.