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Published on: March 6, 2018
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.
Importance:
It has been proposed that grade group (GG) 1 prostate cancer should no longer be defined as cancer but as a precancerous condition. One argument raised by critics is this would decrease adherence with essential monitoring (active surveillance) and therefore lead to increased prostate cancer mortality. However, relabeling GG1 prostate cancer also reduces overdiagnosis and overtreatment, and given that these are the major disincentives to prostate-specific antigen (PSA) screening, it should increase use of prostate cancer screening and thereby reduce deaths from prostate cancer.
Objective:
To model the effects of relabeling of GG1 prostate cancer on prostate cancer mortality in the US.
Design, Setting, And Participants:
In this decision analytical model created in 2025, the number of men with GG1 cancer and those considering prostate cancer screening with prostate-specific antigen were estimated using US population-based and clinical data published from 2020 to 2025.
Exposure:
Relabeling GG1 as a precancerous condition.
Main Outcomes And Measures:
Predicted increase in prostate cancer deaths due to lower adherence with active surveillance vs predicted decrease in prostate cancer deaths due to higher screening rates related to reduced concerns regarding overdiagnosis and overtreatment.
Results:
In the base case, which was relatively conservative, relabeling would lead to 6-fold more annual prostate deaths avoided than caused (2835 vs 452). Numerous scenarios modifying model inputs failed to change this conclusion. For instance, even if active surveillance progression rate increased by 50%, nonadherence rate doubled, and there was only a 10% absolute increase in screening, annual deaths would be reduced by close to 500. Under the base case, there would be a net decrease in mortality even if the absolute increase in screening rates was only 3%.
Conclusions And Relevance:
In this study, dropping the cancer label from GG1 prostate disease and redefining GG1 prostate disease as a precancerous lesion led to a net reduction in estimated prostate cancer deaths. Proponents for retaining the cancer label for GG1 prostate disease should argue relabeling would have close to zero effects on screening rates or that other harms outweigh the benefits of reduced prostate cancer mortality.
