'Let's not call it cancer'

Roughly one in six men will be diagnosed with prostate cancer at some point in their lives, but these cancers usually aren't life-threatening. Most newly diagnosed men have Grade Group 1 (GG1) prostate cancer, which can linger for years without causing significant harms.

Prostate cancer is categorized according to how far it has spread and how aggressive it looks under the microscope. Pure GG1 prostate cancer is the least risky form of the disease. It occurs frequently with age, will not metastasize to other parts of the body, and it doesn't require any immediate treatment.

So, should we even call it cancer? Many experts say no.

Dr. Matthew Cooperberg, who chairs the department of urology at the University of California, San Francisco, says men wouldn't suffer as much anxiety — and would be less inclined to pursue unneeded therapies — if their doctors stopped referring to low-grade changes in the prostate as cancer. He recently co-chaired a symposium where experts from around the world gathered to discuss the pros and cons of giving GG1 cancer another name.

Treatment discrepancies

GG1 cancer is typically revealed by PSA screening. The goal with screening is to find more aggressive prostate cancer while it's still curable, yet these efforts often detect GG1 cancer incidentally. Attendees at the symposium agreed that GG1 disease should be managed with active surveillance. With this standard practice, doctors monitor the disease with periodic PSA checks, biopsies, and imaging, and treat the disease only if it shows signs of progression.

But even as medical groups work to promote active surveillance, 40% of men with low-risk prostate cancer in the United States are treated immediately. According to Dr. Cooperberg, that's in part because the word "cancer" has such a strong emotional impact. "It resonates with people as something that spreads and kills," he says. "No matter how much we try to get the message out there that GG1 cancer is not an immediate concern, there's a lot of anxiety associated with a 'C-word' diagnosis."

A consequence is widespread overtreatment, with tens of thousands of men needlessly suffering side effects from surgery or radiation every year. A cancer diagnosis has other harmful consequences: studies reveal negative effects on relationships and employment as well as "someone's ability to get life insurance," Dr. Cooperberg says. "It can affect health insurance rates."

Debate about renaming

Experts at the symposium proposed that GG1 cancer could be referred to instead as acinar neoplasm, which is an abnormal but nonlethal growth in tissue. Skeptics expressed a concern that patients might not stick with active surveillance if they aren't told they have cancer. But should men be scared into complying with appropriate monitoring? Dr. Cooperberg argues that patients with pure GG1 "should not be burdened with a cancer diagnosis that has zero capacity to harm them."

Dr. Cooperberg does caution that since biopsies can potentially miss higher-grade cancer elsewhere in the prostate, monitoring the condition with active surveillance is crucial. Moreover, men with a strong family history of cancer, or genetic mutations such as BRCA1 and BRCA2 that put them at a higher risk of aggressive disease, should be followed more closely, he says.

Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases, agrees. Dr. Garnick emphasized that a name change for GG1 cancer needs to consider a wide spectrum of additional testing. "This decision can't simply be based on pathology," he says. "Biopsies only sample a miniscule portion of the prostate gland. Genetic and genomic tests can help us identify some low-risk cancers that might behave in a more aggressive fashion down the road."

Meanwhile, support for a name change is gaining momentum. "Younger pathologists and urologists are especially likely to think this is a good idea," Dr. Cooperberg says. "I think the name change is just a matter of time — in my view, we'll get there eventually."

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases, is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives

https://www.health.harvard.edu/blog/lets-not-call-it-cancer-202501093086