Stop using the “C word”? Doctors suggest new names for low-grade prostate cancer

A cancer diagnosis is scary. Some doctors say it’s time to rename low-grade prostate cancer to eliminate the alarming C-word.

Cancer cells grow in almost all prostates as men age, and most prostate cancers are harmless. About 34,000 Americans die each year from prostate cancer, but treating the disease can lead to sexual dysfunction and incontinence.

Changing the name could cause more low-risk patients to avoid unnecessary surgery and radiation therapy.

“It’s the least aggressive and weakest form of prostate cancer that is literally unable to cause symptoms or spread to other parts of the body,” said Dr. Scott Eggener of the University of Chicago Medicine, which rekindles a debate on how to explain the threat. to worried patients.

The words “You have cancer” have a profound effect on patients, Eggener wrote Monday in the Journal of Clinical Oncology. He and his co-authors say that fear of disease can lead some patients to overreact and opt for unnecessary surgery or radiation therapy.

Others agree. “If you reduce anxiety, you reduce overtreatment,” said Dr. David Penson of Vanderbilt University. “The word ‘cancer’ puts an idea in their head: ‘I need to get treatment.'”

Diagnosis sometimes begins with a PSA blood test, which looks for high levels of a protein that can mean cancer, but can also be caused by less serious prostate problems or even vigorous exercise.

When a patient has a suspicious test result, a doctor may recommend a biopsy, which involves taking samples of tissue from the prostate gland. Then a pathologist looks under a microscope and scores the samples to determine how abnormal the cells appear.

Often, doctors offer patients with the lowest score – Gleason 6 – a way to avoid surgery and radiation therapy: active surveillance, which involves close monitoring but no immediate treatment.

In the United States, about 60% of low-risk patients choose active surveillance. But they might still worry.

“I would love it if people came up with a new name for Gleason 6 disease,” Penson said. “It will allow many men to sleep better at night.”

But Dr Joel Nelson, of the University of Pittsburgh School of Medicine, said dropping the word ‘cancer’ would “misinform patients into telling them there’s nothing wrong.” There’s nothing wrong today, but that doesn’t mean we don’t have to keep track of what we’ve discovered.

Name changes have already occurred in low-risk bladder, cervical, and thyroid cancers. In breast cancer, there is an ongoing debate about abandoning DCIS “carcinoma”, or ductal carcinoma in situ.

In prostate cancer, the Gleason grading system of the 1960s evolved, so 6 became the lowest score. Patients may assume this is an average score on a scale of 1 to 10. In fact, it is the lowest on a scale of 6 to 10.

What to call it instead of cancer? Proposals include IDLE for indolent lesions of epithelial origin, or INERRT for indolent tumors rarely requiring treatment.

“I don’t give a damn about what’s called until it’s called cancer,” Eggener said.

Steve Rienks, a 72-year-old civil engineer in Naperville, Illinois, was diagnosed with Gleason 6 prostate cancer in 2014. He chose active surveillance and follow-up biopsies in 2017 and 2021 found no evidence of cancer.

Calling it something else would help patients make informed choices, Rienks said, but that’s not enough: Patients need to ask questions until they feel confident.

“It’s about understanding the risk,” Rienks said. “I would encourage my male colleagues to educate themselves and seek additional medical advice.”

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