When is prostate cancer really cancer?

Area of Science:

• Oncology
• Pathology
• Genomics

Background:

• Prostate cancer (PC) is a leading cause of cancer mortality globally.
• Discussions question the classification of Grade Group 1 (GG1) PC as
• cancer
• due to its indolent behavior and lack of metastatic potential.

Framework:

• An international symposium convened diverse stakeholders to discuss GG1 PC classification.
• Key points included autopsy findings suggesting GG1 is common in aging males, akin to a normal aging process.
• Spatial transcriptomics reveals genomic alterations in non-histologically malignant prostate regions, challenging conventional cancer definitions.

Implementation:

• Pathologists debated diagnostic challenges and heterogeneity, proposing alternative labels like
• acinar neoplasm
• for GG1.
• GG1 requires active surveillance but patient adherence without a cancer diagnosis is uncertain.
• Patient perspectives emphasized the harms of overtreatment and cancer diagnosis burden.

Implications:

• Revising the classification of GG1 PC could significantly improve public health by reducing overdiagnosis and overtreatment.
• This shift may impact screening protocols and treatment strategies across various healthcare systems.
• The ultimate goal is to minimize PC mortality while mitigating harms from diagnostic and therapeutic interventions.