Harvard newsletter lays out pros and cons of renaming Gleason 6/GG 1 as a noncancer

Cooperberg confident Gleason 6 eventually will be renamed

By Howard Wolinsky

In an article entitled “Let's not call it cancer/The lowest-risk type of prostate cancer is never life-threatening. Should we call it something else?,” Harvard Health Publishing presents the case pro and con in its January 9 issue for renaming Gleason 6/Grade Group 1 low-risk prostate cancer as a noncancer.

Gurus like Matthew Cooperberg, MD, MPH , of UCSF, and Scott Eggener, MD, of the University of Chicago, and other leaders have been banging the drums loudly for a name change for years.

Under the microscope, “pure” Gleason 6 looks like a cancer, but it doesn’t act like one. For all practical purposes, Gleason 6 never kills and never spreads. That’s very uncancer-like.

The Eggener 6, including Cooperberg and me, argued for a name change in an article in the Journal of Clinical Oncology entitled Low-Grade Prostate Cancer: Time to Stop Calling It Cancer. The article, best read in the journal in 2022, highlights the fact that the Big C label can cause emotional distress but also financial toxicity, such as denial of life insurance and impediments to job advancement and loss of clients who wonder if we can do the job—even with wimpy Gleason 6s.

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases, discussesthe Gleason 6 debate,

He wrote: “But even as medical groups work to promote active surveillance, 40% of men with low-risk prostate cancer in the United States are treated immediately. According to Dr. Cooperberg, that's in part because the word ‘cancer’ has such a strong emotional impact. ‘It resonates with people as something that spreads and kills,’ he says. ‘No matter how much we try to get the message out there that GG1 cancer is not an immediate concern, there's a lot of anxiety associated with a 'C-word' diagnosis."

Schmidt adds: “A consequence is widespread overtreatment, with tens of thousands of men needlessly suffering side effects from surgery or radiation every year. A cancer diagnosis has other harmful consequences: studies reveal negative effects on relationships and employment as well as ‘someone's ability to get life insurance," Dr. Cooperberg says. ‘It can affect health insurance rates.’”

Schmidt notes that skeptics expressed a concern that patients might not stick with active surveillance if they aren't told they have cancer.

A patient survey I led of 460 patients should allay doctors’ concerns that unmonitored patients will end up with advanced disease and suing them: We found that only 5% of patients said they’d quit surveillance if Gleason 6 were renamed a noncancer ,and 82% would stick with surveillance.

Schmidt asks, “Should men be scared into complying with appropriate monitoring?” Cooperberg argues that patients with pure GG1 "should not be burdened with a cancer diagnosis that has zero capacity to harm them."

Adam Kibel, MD, urology chair at Harvard Medical School, has been among the strongest opponents to the name change. He and Jonathan Epstein, MD, the leading uropathologist, wrote an article in counterpoint to the article by the Eggener 6 in the Journal of Clinical Oncology, entitled Renaming Gleason Score 6 Prostate to Noncancer: A Flawed Idea Scientifically and for Patient Care.

Dr. Marc Garnick, editor-in-chief of the Harvard Medical School Guide to Prostate Diseasess , a medical oncologist specializing in prostate cancer, emphasized that a name change for GG1 cancer needs to consider a wide spectrum of additional testing, such as genetic testing for BrCa mutations,

"This decision can't simply be based on pathology," he said "Biopsies only sample a miniscule portion of the prostate gland. Genetic and genomic tests can help us identify some low-risk cancers that might behave in a more aggressive fashion down the road."

Cooperberg told Schmidt that progress is being made with a name change: "Younger pathologists and urologists are especially likely to think this is a good idea, I think the name change is just a matter of time — in my view, we'll get there eventually."

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Note: Get a preview of the MRI-invisible issue in my article this week in Medscape: https://www.medscape.com/viewarticle/mri-invisible-prostate-lesions-are-they-dangerous-2025a10000cw)

MRI-invisible lesions: A good sign—like a Gleason 6

By Howard Wolinsky

Did you know that it’s possible for prostate cancer can spotted by a pathologist but the lesion can be invisible in an MRI?

Is this a good thing? Many researchers think it is a good thing.

Dr. Mark Emberton, Professor of interventional oncology at University College London and Dean of its Faculty of Medical Sciences, will be speaking to the ASPI webinar on Saturday, January 25, 2025, from noon – 1:30 p.m. Eastern (5:00pm-6:30pm UK time), about MRI-invisible lesions. Emberton is a pioneer on the use of MRIs in diagnosing, classifying and monitoring prostate cancer.

Don’t be invisible. Register here: https://zoom.us/meeting/register/tJYldu-qqzojGNEzCkgPQuTOWYGhcL80Dhec'

MRI-invisible lesionms are considered a good thing comparable to Gleason 6.

(Are you having an MRI-invisible lesion adventure. Let me know.)

Professor Emberton’s clinical research is aimed at improving the diagnostic and risk stratification tools and treatment strategies for prostate cancer (PCa). He specializes in the implementation of new imaging techniques, nanotechnologies, bio-engineering materials and non-invasive treatment approaches, such as high intensity focused ultrasound and photo-dynamic therapy.

His research has been published in over 300 peer-reviewed scientific papers in journals including BMJ, Lancet Oncology and European Urology. He has also contributed to the development of guidelines for the management of PCa and lower urinary tract symptoms, published by the International Society of Geriatric Oncology and the European Association of Urology.

If you have questions, please send them to: contactus@aspatients.org