Should grade group 1 prostate cancer be reclassified as “non-cancer”? A pathology community perspective

Abstract

Overdiagnosis and overtreatment of Grade Group 1 (GG 1) prostate cancer remains a significant health care problem despite of its improved risk assessment and uptake in conservative management. Removing the cancer label from these non-lethal cancers has been proposed as an expedient way to reduce potential physical, psychological and financial harm to patients. Such a nomenclatural change necessitates a multidisciplinary team effort by clinicians and pathologists. Genitourinary Pathology Society recently conducted a survey of its members, gauging their awareness of this controversy and their position on whether GG 1 prostate cancer should be reclassified. Most respondents (196, 81.7%) opposed removing the cancer label from GG 1 cancer, 33 (13.8%) supported a change in nomenclature, while 11 (4.6%) responded that they were uncertain. Of those who supported the reclassification, 17 (51.5%) supported the change for radical prostatectomy only, 4 (12.1%) for biopsy only, and 12 (36.4%) for both biopsy and radical prostatectomy. This survey results highlight the gap between pathologists and clinicians in whether GG 1 prostate cancer should be labeled as “non-cancer,” and calls for continued debates and conversations between pathologists and clinicians, and further studies on the biology, diagnostic reproducibility, and ideal management of GG 1 prostate cancer in order to make a more evidence-based decision for patients.