Low‐grade prostate cancer should still be labelled cancer

Is Gleason 6 cancer? The answer is more than just a ‘name’

“…We acknowledge the uropathology expertise included by Iczkowski et al. [2] but support much of the clinical perspective of Eggener et al., focusing on the beneficial downstream effects of renaming GS6, particularly in the current era of widespread PSA testing, use of multiparametric MRI for evaluation and targeted biopsies, and classification of nearly all GS6 as low to very low risk. Screening should only be conducted if benefits justify harms and costs, rather than to identify an entity based on histopathological criteria.…”

“…The Cambridge dictionary defines cancer as 'a serious disease that is caused when cells in the body grow in a way that is uncontrolled and not normal, killing normal cells and often causing death' [1]. In this issue of BJUI, Iczkowski and a group mainly of uropathologists make an argument in favour of maintaining the existing nomenclature for Gleason score 6 (GS6) disease, stating it should still be labelled 'cancer' based largely on histopathological features consistent with the above definition [2]. Their article rebuts a commentary by Eggener et al [3] that argues that the histological entity termed GS6 disease (now Grade Group 1) should not be labelled 'cancer'.…”

“…Their article rebuts a commentary by Eggener et al [3] that argues that the histological entity termed GS6 disease (now Grade Group 1) should not be labelled 'cancer'. Emphasizing the broad support among uropathologists, the central arguments put forward by Iczkowski et al [2] are: that GS6 demonstrates histological features that define cancer; that this scenario is different from carcinoma in situ in settings such as thyroid and breast cancer and atypical small acinar proliferation; and that information from randomized trials and observational studies conducted prior to widespread PSA screening demonstrated that GS6 disease can, over decades, lead to prostate cancer metastases and death in some men treated with watchful waiting [4,5]. Also, they argue, progress has been made in reducing unwarranted prostatectomies in favour of increased use of active surveillance (AS).…”

Low‐risk prostate lesions: An evidence review to inform discussion on losing the “cancer” label

“…28,29,[76][77][78][79] However, some pathologists argue against such a change on biological grounds, saying that GG1 lesions are morphologically indistinguishable from GG2-5 lesions, share many molecular hallmarks of prostate cancer, and therefore these lesions should retain the "cancer" label. 80,81 They also cite a high prevalence (up to 30%) of sampling variation (e.g., where a GG1 lesion is detected on biopsy in an individual harboring a higherrisk cancer). 80,82 Others have countered by arguing that even if GG1 lesions appear morphologically similar to higher-grade lesions and/or invade the stroma, they consistently behave as precancerous lesions-with extraprostatic extension and metastasis being extremely rare.…”

“…There have been a number of calls to adopt non‐“cancer” labels for low‐risk prostate cancer to reduce potential harms from overdiagnosis and overtreatment 28,29,76–79 . However, some pathologists argue against such a change on biological grounds, saying that GG1 lesions are morphologically indistinguishable from GG2‐5 lesions, share many molecular hallmarks of prostate cancer, and therefore these lesions should retain the “cancer” label 80,81 . They also cite a high prevalence (up to 30%) of sampling variation (e.g., where a GG1 lesion is detected on biopsy in an individual harboring a higher‐risk cancer) 80,82 .…”