PROSTATE cancer is the second leading cause of cancer death worldwide amongst men, however recent research has revealed that far more patients are diagnosed than die of the disease. In 2022, there were nearly 1.5 million cases of prostate cancer, but only 400,000 deaths. This has led experts in the field to suggest that early-stage changes to the prostate should not be deemed ‘prostate cancer’ at all, in order to lessen the burden on patients.
In order to discuss this change to the classification of prostate cancer, researchers came together at an international symposium, with participants from multiple fields, including patient advocacy. Key discussion points included the very high rate of Grade Group 1 (GG1) prostate cancer detectable on autopsy studies, the focus of contemporary diagnostic tests on detecting higher grade cancers, the benefits of relegating GG1 to something more like “incidentaloma” status, the adverse health effects of overtreatment, and the psychological burden of a cancer diagnosis for patients.
The researchers emphasised that while GG1 is common among older men, it should not be considered normal, and that patients with this condition should definitely continue to monitor it with their physicians. Some raised concerns that patients may not consider their condition important enough to monitor if the term ‘cancer’ is not used. Ultimately, however, the team concluded that the goal of prostate cancer screening, diagnosis, and treatment is to bring down mortality rates while also reducing the harms of overdiagnosis and overtreatment. They believed that a reconsideration of nomenclature may prove to be a helpful place to start.
“We are now finding exceptionally common cellular changes in the prostate that in some cases presage the development of aggressive cancer but in most do not. We absolutely need to monitor these abnormalities no matter what we label them, but patients should not be burdened with a cancer diagnosis if what we see has zero capacity to spread or to kill,” commented the experts involved in the research.
Victoria Antoniou, EMJ
Reference
Cooperberg MR et al. When is prostate cancer really cancer? J Nat Cancer Inst. 2024;djae200.
