This 1974 microscope image made available by the Centers for Disease Control and Prevention shows changes in cells indicative of adenocarcinoma of the prostate. Some doctors say it’s time to rename low-grade prostate cancer to eliminate the alarming C word.
Dr. Edwin P. Ewing, Jr., CDC via Associated Press
Would calling low-grade prostate cancer something else reduce the risk of overtreatment and complications in cases that are unlikely ever to put the patient’s health at serious risk? That’s a question being grappled with by some prostate cancer experts.
According to the Associated Press, University of Chicago Medicine’s Dr. Scott Eggener and some of his peers revived the debate in an article in the Journal of Clinical Oncology. The piece suggests that the dreaded C-word — “cancer” — and the fear it causes can lead to complications far worse than the potential a low-grade version of the malady poses.
“Cancer cells develop in nearly all prostates as men age and most prostate cancers are harmless,” according to the Associated Press. “About 34,000 Americans die from prostate cancer annually, but treating the disease can lead to sexual dysfunction and incontinence.”
Eggener and his co-authors said fear can cause patients “to overreact and opt for unneeded surgery or radiation,” risking complications.
Doctors often suggest patients with low-grade prostate cancer — designated as “Gleason 6” — opt for close monitoring to make sure the status of the disease doesn’t worsen. Most American men with low-risk disease choose to do that.
Other experts, however, worry that dropping the word “cancer” would lull patients into thinking that low-risk means no-risk and that they don’t need to be monitored. Dr. Joel Nelson of the University of Pittsburgh School of Medicine told the Associated Press that if there’s no cause for immediate concern, “that doesn’t mean we don’t have to keep track of what we’ve discovered.”
The prostate is a small gland located below the bladder in males. The National Cancer Research Institute says more than half of men diagnosed with prostate cancer are older than 70 and since the cancer typically — but not always — grows very slowly, “many men will live out their whole lives without the cancer being discovered or causing any symptoms.”
Of those who are diagnosed with prostate cancer, many will die “with” the disease, not “of” the disease.
Close to 1 in 8 men will be diagnosed with prostate cancer at some point. It is the No. 2 cause of cancer death in American men, behind lung cancer, according to the American Cancer Society. Prostate cancer is more common in Black men and 1 in 4 will be diagnosed over their lifetime.
Not all prostate cancer is benign. But localized prostate cancer that has not spread and regional cancer that has only spread to nearby structures or lymph nodes has a 5-year relative survival rate of greater than 99% at the time of diagnosis, compared to cases where cancer has spread to parts of the body, like the liver, lungs or bones, the American Cancer Society says. In those cases, about 31% of patients will survive five years or longer after diagnosis. Variables include age, general health and other factors.
The idea of changing a cancer designation isn’t new. Names have already been changed for low-grade bladder, cervical and thyroid cancers.
As early as 2012, a Centers for Disease Control and Prevention State of the Science Consensus meeting suggested changing the terminology, recommending reclassification of low-risk lesions as “indolent lesion of epithelial origin.”
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