A diagnosis of Gleason grade 1 prostate cancer creates a paradox for doctors and patients. The condition is technically classified as cancer, but it behaves differently than aggressive tumors. Researchers are now questioning whether this terminology causes more harm than good, specifically by driving men toward unnecessary treatments.
Using the word “cancer” for this condition may push men to seek aggressive interventions. In the United States, roughly 1,000 men are diagnosed with this specific grade each year, and a substantial portion chooses to undergo treatment despite the low risk of spread. While the disease is technically precancerous, it cannot metastasize or spread to other parts of the body, meaning it rarely poses an immediate threat to life.
Redefining the terminology
University of California researchers at UCLA developed a mathematical model to analyze the impact of changing the name. The team found that dropping the word “cancer” could reduce the number of men seeking treatments that offer little benefit. The study, published in JAMA Oncology, suggests this change might also increase screening rates, potentially saving lives.
When the team modeled the relabeling of Gleason 6 prostate cancer as Gleason 1 prostate disease, they projected different outcomes based on screening behaviors. If the new name encouraged more men to get screened, the change could prevent approximately 2,835 prostate cancer deaths annually. However, if fewer men pursued screening, the model predicted 452 additional deaths.
Experts suggest that framing the diagnosis as a less threatening condition, such as a “nasty skin mole,” might help men understand the low risk and avoid unnecessary medical interventions. The study highlights a conflict between legal obligations to use the term “cancer” and the clinical reality that this specific condition rarely poses an immediate threat to life.
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Guidelines recommend men diagnosed with this condition stick with active surveillance, which includes prostate-specific antigen (PSA) testing, magnetic resonance imaging (MRI) scans and regular biopsies to make sure it has not progressed to become cancerous. One exception might be young men with a strong family history of prostate cancer.
The mathematical analysis presented in the publication indicates that a name change could significantly alter patient behavior. By removing the stigma associated with the word “cancer,” providers might help patients accept a monitoring strategy instead of surgical or radiation options.
“Medicine has a history of redefining conditions when the terminology no longer accurately reflects risk,” Scott Eggener, senior author on the study and chairman of the department of urology at the David Geffen School of Medicine at UCLA, said in a statement. He pointed out that similar changes have happened in other cancers, such as bladder, cervical and thyroid cancers.
Ultimately, the goal is to align medical terminology with the actual prognosis of the condition. The findings highlight the need to reconsider how providers discuss low-risk prostate cancer with men.
