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A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer

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Prostate Cancer Mortality After Relabeling Low-Grade Prostate Cancer as Precancerous.

Andrew J Vickers¹, Matthew Cooperberg², Christian P Pavlovich³

¹Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.

|May 21, 2026

Summary

Redefining Grade Group 1 (GG1) prostate cancer as precancerous could reduce prostate cancer deaths by increasing screening adherence. This change may prevent more deaths than it causes, improving overall outcomes.

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Area of Science:

Oncology
Urology
Public Health

Background:

Prostate cancer diagnosis involves Grade Group 1 (GG1), often considered for active surveillance.
Concerns exist that relabeling GG1 as precancerous may reduce monitoring adherence and increase mortality.
Conversely, relabeling could decrease overdiagnosis and overtreatment, potentially boosting prostate-specific antigen (PSA) screening rates.

Purpose of the Study:

To model the impact of relabeling GG1 prostate cancer as a precancerous condition on prostate cancer mortality rates in the United States.
To evaluate the balance between potential decreases in active surveillance adherence and increases in PSA screening rates.

Main Methods:

A decision-analytical model was developed in 2025.
US population-based and clinical data from 2020-2025 were used to estimate numbers of men with GG1 cancer and those undergoing PSA screening.
The model compared predicted changes in prostate cancer deaths due to altered active surveillance adherence versus changes due to increased screening.

Main Results:

In a conservative base case, relabeling GG1 as precancerous was predicted to result in a net reduction of prostate cancer deaths, avoiding approximately 6 times more deaths than caused (2835 vs 452 annually).
Sensitivity analyses showed that even with significant increases in active surveillance progression and nonadherence rates, a modest increase in screening (3-10%) led to a net decrease in mortality.
The model indicated a net mortality reduction even with only a 3% absolute increase in screening rates.

Conclusions:

Redefining GG1 prostate disease as a precancerous lesion, rather than cancer, is projected to lead to a net decrease in estimated prostate cancer deaths.
Arguments for retaining the cancer label for GG1 disease must demonstrate minimal impact on screening rates or that other harms outweigh the benefits of reduced mortality.