A growing number of prostate cancer experts argue that calling the lowest-risk prostate cancer “cancer” does more harm than good. A new UCLA-led study found removing the cancer label could dramatically reduce overtreatment and encourage more men to get screened, potentially leading to significantly fewer deaths from aggressive prostate cancer.
Using a model based on U.S. population data, the researchers estimated that relabeling Grade Group 1 (GG1) prostate cancer — the earliest and lowest-risk form of the disease — as a precancerous condition could reduce unnecessary treatment and prevent nearly 2,400 prostate cancer deaths annually. The researchers found this benefit would largely come from more men choosing PSA screening, as relabeling GG1 could reduce concerns about overdiagnosis and unnecessary treatment among patients and clinicians.
A large body of research has shown that a pure GG1 cannot cause symptoms or metastasize. Guidelines therefore recommend active surveillance (including PSA testing, MRI and periodic biopsies) rather than treatment for nearly all men diagnosed with GG1. Nevertheless, up to 40% of men in the United States with GG1 continue to get treatment.
The findings, published in JAMA Oncology, challenge the long-held assumption that keeping the “cancer” label is necessary to ensure patients continue monitoring their disease.
“Medicine has a history of appropriately redefining conditions when terminology no longer accurately reflects risk,” said Dr. Scott Eggener, Chair of the Department of Urology at the David Geffen School of Medicine at UCLA and senior author of the study. “Similar changes have occurred in other cancers, including bladder, cervical, and thyroid cancers, where some conditions once classified as cancer have been redefined to better reflect their extremely low likelihood of causing harm. It has even happened before in prostate cancer. For the lowest-risk prostate tumors, removing the cancer label could help patients avoid unnecessary treatment and encourage screening approaches that can further reduce deaths from aggressive prostate cancer.”
Unlike aggressive prostate cancers that can spread throughout the body, GG1 prostate cancer, also known as Gleason 6 prostate cancer, typically grows slowly over years or decades, or not at all. These tumors do not cause symptoms or become life-threatening unless a higher-grade cancer develops in the prostate.
But the diagnosis itself can be difficult for patients to process.
Research has shown that men diagnosed with GG1 typically experience stress and anxiety, and many choose surgery or radiation even when active surveillance would be the most appropriate option. Those treatments can cause long-term complications, including urinary, bowel, and sexual dysfunction. In addition, patients unnecessarily lose access to life insurance because of the cancer diagnosis.
The authors also note that calling these tumors “cancer” contributes to overtreatment because patients may assume the disease is more dangerous than it is.
“Changing the terminology does not mean ignoring these tumors or eliminating follow-up care,” said Eggener, who is also a member of the UCLA Health Jonsson Comprehensive Cancer Center. “It means recognizing that not all prostate cancer carries the same risk and language should better reflect the biology of the disease.”
Not all experts, however, agree that the cancer label should be removed. Critics argue that relabeling GG1 disease as a precancerous condition could cause some patients to underestimate the importance of ongoing monitoring and become less likely to follow active surveillance recommendations.
If fewer patients continue surveillance, some tumors might later become more aggressive and go undetected, potentially leading to more advanced disease and deaths.
To examine this concern, the researchers built a decision-analytical model to predict both the potential harms and benefits of relabeling GG1 prostate disease. The model incorporated U.S. population data and findings from previously published studies to estimate how changes in patient behavior could affect prostate cancer mortality.
Using this data, the researchers estimated that about 100,000 men each year are diagnosed with GG1 prostate disease and modeled the potential impact if some patients became less likely to follow active surveillance after the terminology was changed. They then compared those potential deaths with the number of deaths that could be prevented if relabeling encouraged more men to undergo PSA screening by significantly reducing concerns about overdiagnosis and overtreatment.
Using a range of scenarios, including cases where adherence to active surveillance declined more than expected and screening rates increased only modestly, the model consistently predicted a net reduction in prostate cancer deaths.
In their primary analysis, the researchers estimated that relabeling GG1 would prevent approximately 2,835 prostate cancer deaths annually through increased screening, while potentially causing about 452 additional deaths if some patients did not continue active surveillance. Overall, the model predicted a net reduction of nearly 2,400 prostate cancer deaths each year.
The findings remained consistent across multiple sensitivity analyses that tested more extreme assumptions, including higher rates of patients discontinuing surveillance, greater disease progression risks and smaller increases in screening. The researchers found that even a modest improvement in screening that reduced metastatic prostate cancer by only 3% would still result in fewer prostate cancer deaths overall.
Because the study used a mathematical model rather than following patients over time, the findings depend on assumptions about how patients and physicians would respond to a change in terminology.
The researchers noted that future studies will be needed to understand how relabeling would affect real-world screening decisions, patient behavior and long-term outcomes.
Still, the researchers said the findings highlight the need to reconsider how low-risk prostate cancer is classified and communicated to patients.
“Patients deserve information that reflects the actual risk of their disease, not just a label that may create fear or confusion,” said Eggener. “Our hope is that this work encourages a more thoughtful approach to how we define and communicate low-risk prostate cancer.”
The study’s first author is Dr. Andrew Vickers from Memorial Sloan Kettering Cancer Center. Other authors include Dr. Matthew Cooperberg and Dr. Peter Carroll from the University of California, San Francisco, and Dr. Christian Pavlovich from the Johns Hopkins University School of Medicine.
https://www.uclahealth.org/news/release/should-lowest-risk-prostate-cancer-still-be-called-cancer
