乌鸦传媒

Prostate-specific antigen (PSA) screening for prostate cancer (PCa) remains highly controversial, largely because it is unclear whether the primary benefits of reducing rates of metastases and cancer mortality are worth the risks of overdiagnosis, overtreatment, and potential treatment-related morbidity. A major contributing factor to overdiagnosis and overtreatment is the designation of a particular pattern of low-grade cellular changes in the prostate as cancer, which, in our view, should not be called cancer. A simple terminology change for these lesions and removal of the cancer label would dramatically reduce overdiagnosis and overtreatment and markedly change the cost-benefit calculus of PSA screening. Although proposed previously, it never became a widespread discussion with material impact. We feel that revisiting this proposal is timely, compelling, relevant, and of utmost importance.

The histologic grading system for PCa encompasses remarkable diversity -- from nearly universal indolence (Gleason score [GS] 6) to almost certain eventual lethality (GS10) -- and drives nearly all management decisions in localized PCa.

We review the inert clinical behavior of GS6 PCa, ongoing concerns regarding widespread overdiagnosis and overtreatment, and the rationale for a change in nomenclature.

Renaming GS6 is important for public health. A sensible path forward requires input from many stakeholders, including pathologists, urologists, radiation oncologists, patients, and partners. The exact relabeling is not pertinent except for it not including cancer, as most people understandably associate the word with an aggressive and possibly lethal malady.

Regardless of what tempering terms might be used, if the disease label includes cancer, it affects mental health, modulates decisions and behavior, and increases tolerance for treatment-derived toxicities. In breast cancer, as in PCa, nomenclature directly affects the likelihood of patients electing aggressive treatment. Every PCa clinician observes this phenomenon on a regular basis.

The conversation is necessary and should be multidisciplinary, but the ultimate nomenclature decision will depend on genitourinary pathologists, ideally with input from other specialists and patient advocates. We feel that platforms within individual specialty meetings, multidisciplinary conferences, and even symposiums singularly focused on GS6 are key to addressing this important public health issue.

Even if GS6 is biologically inert, its labeling is not, as it has an important influence and tangible consequences on how patients, providers, and the general public react and respond. We believe that a name change should be thoroughly discussed, vetted, and ultimately adopted. If ultimately deemed appropriate, there will be predictable and unforeseen obstacles, requisite educational campaigns, and large-scale implementation efforts. Nevertheless, we feel that rescinding the cancer label from GS6 would dramatically improve individual and public health.

The data are compelling, the moral imperative is sound, and the time is overdue.

Read the commentary here.