What’s in a name? The push to rebrand the most common type of cancer

Doctors are debating whether low-risk prostate cancers should no longer be called cancer, with a group of international experts suggesting many cases are “a normal aspect of ageing”.

A new paper, co-authored by doctors from countries including Australia, suggests that stripping the emotive word “cancer” from low-grade prostate cancer diagnoses would reduce anxiety and unnecessary treatment.

Prostate cancer is the most commonly diagnosed cancer in Australia.Credit:

They said renaming an early-stage prostate cancer known as grade group 1 (GG1) as “acinar neoplasm” – which refers to an abnormal growth in a gland – had the broadest support.

The Journal of the National Cancer Institute paper said that “many believe public health would on balance greatly improve if GG1 – along with lesions in other organs with no capacity to cause symptoms or threaten life – were labelled something other than ‘cancer’”.

Prostate cancer is the most commonly identified cancer in Australia, with an estimated 26,400 men diagnosed with the disease last year. About 3900 Australians die from the disease each year.

But some experts say that low-risk cases are so common among older men, and unlikely to spread beyond the prostate or lead to mortality, that a cancer diagnosis and treatment can do more harm than good.

Autopsy studies have found that about 60 per cent of men in their 60s have signs of prostate cancer. The paper said that “autopsy studies reveal GG1 is so common in ageing males as to be perhaps a normal aspect of ageing”.

Dr Renu Eapen, a urologist at the Peter MacCallum Cancer Centre who took part in expert discussions as part of the paper, said a great deal of stigma surrounded the word cancer.

“It gives patients, their relatives and sometimes even doctors anxiety,” she said. “It causes stress and impacts on quality of life.”

Eapen said many men with low-risk prostate cancer chose to have invasive and unnecessary treatment because they could not accept this level of anxiety in their lives.

Dr Renu Eapen, a urologist at the Peter MacCallum Cancer Centre.

She said this treatment, which often included surgery to remove the prostate, and radiotherapy, should be avoided unless necessary because it could cause erectile dysfunction, sexual dysfunction and urinary incontinence.

“Our challenge as urologists is not to even diagnose grade group 1 prostate cancer,” she said. “We don’t want to know about it because we don’t want to treat it. Treatment carries a lot of morbidity that impacts on quality of life.”

Eapen said while renaming grade 1 prostate cancer could benefit patients and the health system, she did not believe it would garner enough support in Australia.

“In Australia, the issue of overtreatment of low-grade cancer is much less of an issue as we routinely use MRI scans to avoid doing a biopsy in the first place, and even when we find low-grade cancer, we have very high rates of surveillance rather than treatment,” she said.

Sarah Weller, Movember’s global director of prostate cancer, called for more research into the impact of not calling low-risk forms of the disease cancer. “Cancer is a very strong word that can often cause somebody to face their own mortality, even if they’re not likely to die from it,” she said.

Weller said that while renaming low-risk prostate cancer might reduce overtreatment, it could also trivialise the condition and lead to fewer people engaging in active surveillance.

About 80 per cent of Australian men with grade 1 prostate cancer engage in active surveillance, which involves regular monitoring of the condition through blood tests and MRIs, rather than treatment.

Low-risk cancers of the bladder, thyroid and cervix have previously been renamed “lesions”.

Symptoms of early prostate cancer can include difficulties passing urine, frequent passing of urine and incontinence. Signs of more advanced prostate cancer may include blood in urine, pain during urination and lower back or pelvic pain.

The Prostate Cancer Foundation of Australia recommends that men have a conversation with their doctor about prostate-specific antigen testing when they are 50. Men who have symptoms or come from a family with a history of prostate cancer should have these discussions about the age of 40.

“Your doctor should fully explain your risk factors and the potential benefits and possible harms of testing before you make your decision,” it states. “The harms of PSA testing may outweigh the benefits for men aged 70 and older.”

Anne Savage, chief executive of the Prostate Cancer Foundation of Australia, said while there was a minimal risk of low-risk prostate cancers becoming more aggressive, they still required regular monitoring and follow-up.

She warned that downgrading their name could deter early detection and monitoring of the disease.

“Giving grade group 1 cancers another name will not change the fact that, pathologically, these are cancers,” she said.

Savage said public education and awareness were the best ways of minimising the potential risks of overdiagnosis and overtreatment.

“We need to approach this in much the same way Australians approach skin cancers,” she said. “All of us appreciate that melanomas are particularly deadly and can easily differentiate between melanomas and less aggressive skin cancers like basal and squamous cell carcinomas.”

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