Getting passed the ‘c-word’: Should GG1 prostate disease even be called ‘cancer’?

Dropping the cancer label from GG1 prostate disease and redefining GG1 prostate disease as a precancerous lesion may lead to a net reduction in estimated prostate cancer deaths, according to a study published in JAMA Oncology. The study suggests that relabeling GG1 prostate cancer also may help reduce overdiagnosis and overtreatment. These two factors are major disincentives to prostate-specific antigen (PSA) screening—something a name change could theoretically combat. The team created a decision analytical model that estimated the number of men with GG1 cancer and those considering PSA screening using U.S. population-based and clinical data published from 2020 to 2025. The researchers found that removing the cancer label could dramatically reduce overtreatment and encourage more men to get screened, potentially leading to significantly fewer deaths from aggressive prostate cancer.“The findings are not at all surprising; if anything, I suspect our numbers in terms of numbers of lives potentially saved are conservative. There is no real question that PSA-based early detection, especially midlife, baseline testing, can identify potentially lethal disease, the treatment of which can save many thousands of lives and help reduce disparities too. The downside has always been over-diagnosis and subsequent over-treatment,” said Dr. Matthew R. Cooperberg, a professor of Urology and Epidemiology & Biostatistics and vice-chair of Translational and Population Science Research, and co-Leader UCSF Comprehensive Cancer Center, and chief of Urology, San Francisco VA Medical Center.He said if we choose not to diagnose “cancer” among those at negligible risk of dying of the disease, we shift the balance substantially in favour of screening. “PSA testing should be as routine as colonoscopy, but colonoscopy only works because we don’t call colon polyps “cancers” and only very rarely consider removing or radiating the colon for polyps,” Dr. Cooperberg told the Medical Post.Using a model based on U.S. population data, the researchers estimated that relabeling Grade Group 1 (GG1) prostate cancer (the earliest and lowest-risk form of the disease) as a precancerous condition could reduce unnecessary treatment and prevent nearly 2,400 prostate cancer deaths annually. The researchers found this benefit would largely come from more men choosing PSA screening, as relabeling GG1 could reduce concerns about overdiagnosis and unnecessary treatment among patients and clinicians.Dr. Scott Eggers, chair of the Department of Urology at the David Geffen School of Medicine at UCLA and senior author of the study, said a large body of research has shown that a pure GG1 does not cause symptoms or metastasize. Subsequently, guidelines recommend active surveillance (including PSA testing, MRI and periodic biopsies) rather than treatment for nearly all men diagnosed with GG1. He said medicine has a history of appropriately redefining conditions when terminology no longer accurately reflects risk. He noted that similar changes have occurred in conditions affecting other parts of the body, including with bladder, cervical and thyroid cancers, where some conditions once classified as cancer have been redefined to better reflect their extremely low likelihood of causing harm. Research has shown that men diagnosed with GG1 typically experience stress and anxiety, and many choose surgery or radiation even when active surveillance would be the most appropriate option. Those treatments can cause long-term complications, including urinary, bowel and sexual dysfunction. In addition, patients in the U.S. unnecessarily lose access to life insurance because of the cancer diagnosis. The authors note that calling these tumours “cancer” contributes to overtreatment because patients may assume the disease is more dangerous than it is.Not all prostate cancers carry the same risk and language should better reflect the biology of the disease. Dr. Eggers said patients deserve information that reflects the actual risk of their disease, not just a label that may create fear or confusion. However, not all experts agree that the cancer label should be removed. Critics argue that relabeling GG1 disease as a precancerous condition could cause some patients to underestimate the importance of ongoing monitoring and become less likely to follow active surveillance recommendations.If fewer patients continue surveillance, some tumours might later become more aggressive and go undetected, potentially leading to more advanced disease and deaths. To examine this concern, the researchers built a decision-analytical model to predict both the potential harms and benefits of relabeling GG1 prostate disease. The model incorporated U.S. population data and findings from previously published studies to estimate how changes in patient behaviour could affect prostate cancer mortality.Using this data, the researchers estimated that about 100,000 men each year are diagnosed with GG1 prostate disease and modeled the potential impact if some patients became less likely to follow active surveillance after the terminology was changed. They then compared those potential deaths with the number of deaths that could be prevented if relabeling encouraged more men to undergo PSA screening by significantly reducing concerns about overdiagnosis and overtreatment.Using a range of scenarios, including cases where adherence to active surveillance declined more than expected and screening rates increased only modestly, the model consistently predicted a net reduction in prostate cancer deaths. In their primary analysis, the researchers estimated that relabeling GG1 would prevent approximately 2,835 prostate cancer deaths annually through increased screening, while potentially causing about 452 additional deaths if some patients did not continue active surveillance. Overall, the model predicted a net reduction of nearly 2,400 prostate cancer deaths each year.The findings remained consistent across multiple sensitivity analyses that tested more extreme assumptions, including higher rates of patients discontinuing surveillance, greater disease progression risks and smaller increases in screening. The researchers found that even a modest improvement in screening that reduced metastatic prostate cancer by only 3% would still result in fewer prostate cancer deaths overall.Because the study used a mathematical model rather than following patients over time, the findings depend on assumptions about how patients and physicians would respond to a change in terminology. “Names in medicine matter. The word cancer dates back 2,500 years and has extremely deep cultural resonance. Relatively recently, we started to define cancer based on how it looks under a microscope, and only for a couple decades have we been telling patients that some cancers are low-risk and non-threatening. Many people, understandably, just can’t get past the “c-word,” and we need to rethink how we use the word in medicine,” Dr. Cooperberg told the Medical Post. Reference:Vickers AJ, Cooperberg M, Pavlovich CP, Carroll P, Eggener S. Prostate Cancer Mortality After Relabeling Low-Grade Prostate Cancer as Precancerous. JAMA Oncol. Published online May 21, 2026. doi:10.1001/jamaoncol.2026.1391

Getting passed the ‘c-word’: Should GG1 prostate disease even be called ‘cancer’?

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