Is the "cancer" label appropriate for Gleason 6/low risk?

Recent evidence seems to demonstrate that Gleason score 6 or less tumors do not metastasize outside the prostate/seminal vesicles.

Do adenocarcinomas of the prostate with Gleason score (GS) ≤6 have the potential to metastasize to lymph nodes? (Answer=No)

What's more, we know from cadaver studies that prostate cancer typically follows an indolent course and rarely becomes lethal. Since widespread PSA screening began in the 1990's, most men are now diagnosed with Gleason 6 and low risk disease (T1c or T2a and PSA<10). 90% of diagnosed men choose radical treatment (prostatectomy or radiation), and suffer the harms associated with those treatments. It is generally agreed that there has been an epidemic of overtreatment associated with this.

While many Gleason 6 (3+3) tumors may never progress, some will. Some Gleason 6s on biopsy are found to have been higher grade after prostatectomy. Grade 4 or 5 cells most likely progressed from G3s. Gleason scores of 7, 8, 9 and 10 all have metastatic potential.

Cancer is a loaded word. We all have friends and relatives who have died from it in one form or another, or who suffer from it. There is common wisdom associated with the word -- catch it early, treat it early and definitively, get it out...

So I've been wondering if we have a labeling problem. If most Gleason 6 is indolent and will never progress or metastasize, should Gleason 6/low risk be labeled "cancer," or will the "cancer" label itself inevitably lead to overtreatment?

Post Edited (Tall Allen) : 5/17/2013 12:59:10 PM (GMT-6)

""prostate cancer typically follows an indolent course and rarely becomes lethal.""
Really? Tell that to all the men who have died from it.

I don't get it.

Why do you constantly barrage the forum touting, No Treatment Needed, Mislabeled, Over-diagnosed, Over-treated, Don't screen, Prostate Cancer will not kill you, and all the other stuff. Are you mad because you had cancer?

Again, I don't get it.

It is very clear that prostate cancer does indeed kill. To try and tell men otherwise, is a great dis-service.

My Biopsy was a G6 and I was told that I had the option of watchful waiting.  I said get this out of me now!  Well they did and you can see from my post path that I was not a 6 but a 7 and a T3B to boot!  I would recommend that anyone with an above normal PSA and a G6 to get it out if possible....just my two cents. The only way to know the full extent of your condition is to get it out and have a post path!   If I error.. it will be a proactive error!  

Rider:

I understand what you're saying. But it is relentless by a very few people.

This is a peer to peer support group first and foremost.

We have a brother up top who has just posted about his great results on his surgery for his G6 CANCER. And now he is also greeted by someone telling him he just operated on something that didn't require an operation and shouldn't even be called CANCER. Now, besides the actual merits of the issue, which I think Tall Paul is severely lacking on, at the very bloody least it's a anti social and frowned upon, specially on a forum designed to provide support and information. It's anti-social.

I never joined live support groups precisely because things like this. You cannot have support when surrounded by agenda relentless driven people and for my taste, you don't get support by endless sand nothing other than "academic" interpretations and approaches. The most effective way of over coming this, in my opinion, is mostly through our spirit, not only intellect or pseudo intellect. I think a great thing is being systematically tainted here and I'm saying it on my way out. And if I were in Paul's live group I'd tell him to his face.

Post Edited (davidg) : 5/17/2013 2:07:20 PM (GMT-6)

From what I see G 3+3 cells doing, I would certainly call it cancer.
It may be a slow growing cancer, but it is cancer.

As expressed in your last sentence, your really asking if G6 cancers should be treated, because you feel there is overtreatment of G6 cancers. I feel this is a question best answered by an informed individual. I would hate think that the question would be answered by an insurance company or a government body.

how many G6 guys are not G6 after they are "overtreated" with surgery?

Davidg, while you obviously disagree with Tall Allen's post, don't you think you might do so in a little more respectful manner? He is certainly entitled to his opinion and I also think he is entitled to civility. Think about it.

Jim

iSpark,
When the analysis of cadavers was done it was in men that died of unrelated causes and had no prior diagnosis of prostate cancer. Even children/adolescent males were analyzed long before they were ever in danger from PCa.

The study is posted on the SEER website for the National Institute of Health.

Tony

JHU has suggested that PCa be identified by Roman numerals I to V. With G6 being a I (a V being G 9-10) so that newly diagnosed patients will see the true(er) view of their situation. A score of 6 out of 10 makes it sound like it is on the high side of the scale when it is not. I like the JHU idea.

I think there are subsets of G6 cancers that may be looked at at not being cancers, but certainly not all G6s, especially the high volume ones. Some G6s are faster growing than others and they may not metastasize, but they can grow into the bladder and anal wall.
Other G6 cancers, especially those with <5% core volume are truly VERY low risk and there are a lot of good reasons to reclassify them as other than cancers due to their harmless nature and the prevalence of these. Dr Oppenheimer, the noted pathologist has been preaching this for a long time. Many times these found on biopsies are not even tumors, but cancer clusters that disappear on their own or never grow into a tumor. To treat these as prostate cancer tumors is like calling a freckle a cancerous tumor.
Changing the name of a cancer to something else is not unheard of. It was done about 10 years ago when pathologists choose not to report G5 as a cancer for similar reasons.
What I'm tired of hearing is that there are no ways to distinguish indolent from aggressive cancer. Nothing is further from the truth. There are new pathology tests as well as scans that can accurately determine status. The AS protocols now available at major institutions like Hopkins and UCSF have been very accurate in identifying progression well before any treatment window of opportunity is lost.
The evidence is overwhelming that G6 cancers with low volume, low psa density, and psa doubling time > than 3 years are pretty much harmless and can be safely monitored. G6s that fall out of this range are much more risky and can result in 2% to 5% mortality in 20 years if not treated. These are still pretty good odds considering that results of delayed treatment upon identified progression has the exact same statistical results as immediate treatment. A successful AS program is one that identifies the cancers that will progress and treats them, leaving the harmless cancers untreated.
Many well respected doctors hold the opinion that certain G6s are not cancers, Scholz, Oppenhiemer, Bahn, all experts on PC, so to berate Tall Allen for bring this up is way out of line.
JohnT

What I'm tired of hearing is that there are no ways to distinguish indolent from aggressive cancer. Nothing is further from the truth. There are new pathology tests as well as scans that can accurately determine status.

then doctors no longer have an excuse for "causing harm"? when will these new tests go into effect for the masses -- joe average with Kaiser insurance? 

and wouldn't it be wiser to increase PSA testing -- not decrease -- since doctors will no longer be overtreating patients?

ed 

thanks for confirming what I already knew Tony.  man can travel to the moon too but i'll never go there .

ed

 

F8,
Unfortunately most doctors and patients have no idea of the diagnostics that are available. Unless you are on a forum like this or YANA it is doubtful that a patient will ever know what is actually available to assist in staging his cancer. We've know for years that a high PAP is the best indicator of primary treatment failure, more accurate than Gleason or PSA. How many patients with an intermediate or high grade risk status were given a PAP test before a primary treatment? This is just one example of diagnostics that are cheap and available but rarely used before recommending a treatment. How many biopsies are given without a free PSA or a PCA3 or a short course of antibiotics? these are simple, available and could eliminate thousands of unnecessary biopsies. The diagnostic tools are there; patients just have to know about them.