Prostate cancer remains the most commonly diagnosed cancer in men in the United States, with nearly 300,000 new cases expected by the end of 2024. According to the American Cancer Association, prostate cancer will affect one in eight men in their lifetime. Notably, most men diagnosed with prostate cancer will not die from the disease. Experts anticipate about 35,000 prostate cancer moralities this year, resulting in a mortality risk of one in 44. Because of the relatively low rates of prostate cancer-related deaths, we have more than three million prostate cancer survivors living in the United States today.
These statistics underscore a significant bottom line - prostate cancer incidence far outweighs prostate cancer mortality. These conclusions stem, in part, from advances that have allowed prostate cancer diagnoses of very low-grade disease. In other words, typically indolent prostate cancer cases, categorized as Grade Group 1 (GG1) prostate cancer, significantly increase incidence rates but rarely result in deaths. This fact has led some experts to question whether doctors should label these particular cases of low-grade prostate cancer as “cancer.” An important question arises: could harms associated with how we talk about GG1 prostate cancer negatively impact patients?
Fears, stress, and anxiety could have negative implications, which may not lead to meaningful benefits in the treatment of low-grade prostate cancer cases. In addition, some experts wonder if diagnoses could lead to overtreatment in which toxicities and side effects may outweigh the anti-cancer benefits. To address these questions, a wide range of stakeholders convened for discussions, and they published a summary of the discussions in the Journal of the National Cancer Institute today. Overall, the group sought to “reduce prostate cancer mortality while minimizing harms associated with both overdiagnosis and overtreatment.”
The authors, including a group referred to as the “CANCER-GG1 Writing Group,” noted several key points that contributed to their discussions. Notably, autopsy data revealed that GG1 cases occur so often in older men that it could be considered a characteristic of normal aging. Thus, many older men may die with GG1 prostate cancer, not from the disease. Further, because GG1 disease cannot metastasize, diagnostic standards often exclude biopsies if doctors suspect low-grade disease. The lack of potential to spread and little added benefit from further study from a biopsy highlights the minimal risk associated with these cases.
Patient advocates involved in the discussions underscored concerns related to side effects associated with overtreatment as well as the emotional burden of a cancer diagnosis.
The group stresses that GGP1 should not be considered “normal” and requires ongoing surveillance. In this regard, they discussed alternative nomenclature that could alleviate some of the emphasis placed on low-grade diseases. One concern that remains on the question of whether patients would adhere to surveillance without a cancer diagnosis.
Overall, many in the group believed that public health would benefit if doctors refrained from labeling GG1, and other low-grade cancers that do not cause symptoms or mortality, as cancer. This shift in perspective could lead to a reduction in unnecessary treatments and a decrease in the emotional burden associated with a cancer diagnosis, offering a more hopeful outlook for patients.
Sources: CA Cancer J Clin, J Natl Cancer Inst