This cancer should be "removed"?

▎WuXi AppTec Content Team Editor Recently, the Journal of Clinical Oncology, an internationally renowned clinical oncology journal, published an article pointing out that low-grade prostate cancer may no longer be called "cancer".
Removing low-risk lesions from prostate cancer may significantly reduce overdiagnosis and overtreatment of prostate cancer and improve the cost-effectiveness of PSA screening
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The paper emphasizes that low-grade prostate cancer does not invade other organs, and less than 1% of patients will develop disease metastasis or die within 15 years of initial diagnosis
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Overtreatment of these patients often results in unnecessarily serious side effects, such as sexual dysfunction or urinary incontinence
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Screenshot source: JCO prostate-specific antigen (PSA) is an important indicator for the detection of prostate cancer, but there is still a lot of controversy using PSA for prostate cancer screening
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On the one hand, abnormal PSA test results may be caused by some less serious prostate problems, or even strenuous exercise; on the other hand, the benefits of PSA screening in reducing prostate cancer-related metastasis or death may not outweigh it.
The attendant risk of overdiagnosis, overtreatment and even potential treatment-related death
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When blood PSA tests are abnormal, doctors may recommend a biopsy, which is a tissue sample of the prostate taken for analysis
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The pathologist grades the sample by microscopic observation to determine how abnormal the prostate cells are in appearance
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It should be pointed out that, according to the results of pathological diagnosis, the vast majority of prostate cancer patients may be low-grade (ie, Gleason score 6) prostate cancer
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▲More than 50% of men (>50 years old) have prostate cancer; up to 50% of low-grade patients receive radiotherapy/surgery; low-grade patients have less than 1% metastasis/mortality within 15 years (US data) (Image source: Reference [ 1]) Although low-grade prostate cancer meets the pathological criteria of cancer (ie, the diseased cells invade the stroma), such diseased cells do not invade adjacent local structures or form metastases
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Therefore, low-grade prostate cancer is not significantly aggressive and usually causes no associated symptoms
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Previous studies have shown that metastasis/mortality within 15 years of low-grade prostate cancer is even less than 1%
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The paper points out that the most common cause of overdiagnosis and overtreatment in prostate cancer is the identification of these "low-grade altered cells" as cancer cells
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Fear of cancer can cause some patients to overreact, and up to 50% of patients with low-grade prostate cancer will choose to undergo unnecessary surgery or radiotherapy to eradicate these generally inert cells
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However, overtreatment often leads to side effects such as sexual dysfunction or urinary incontinence
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The authors of the paper emphasize that patients with low-grade prostate cancer only need active surveillance, not immediate treatment
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Removing such clinically low-risk lesions from prostate cancer may eliminate patient fears, significantly reduce overtreatment of prostate cancer, and significantly increase the cost-benefit of PSA screening
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In the future, we may be able to name low-grade prostate cancer "indolent lesions of epithelial origin (IDLE)" or "indolent tumors rarely requiring treatment (INERRT)", thus suggesting that some clinically low-risk prostate cancer patients are exempt from unnecessary treatment
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