Sometimes, what happens locally stays local, particularly in early prostate cancer. When that occurs, as it frequently does, perhaps it's better not to even call it cancer?

Prostate cancer is the second leading worldwide cause of death from cancer among men. In the U.S., the National Cancer Institute estimated 280,000 were diagnosed with the disease in 2023, with an estimated 34,700 (about 12 percent) dying from prostate cancer.

“ …Patients should not be burdened with a cancer diagnosis if what we see has zero capacity to spread or to kill.”

Many patients are told they have “early-stage cancer” because, on a routine physical, the lab work shows that their prostate specific antigen (PSA) blood test is elevated, usually above 4, despite the digital physical exam being normal.

Men who receive this early-stage cancer diagnosis are likely to have a follow-up pelvic x-ray exam that is also normal, with no indication that any prostate cancer cells have spread to nearby tissue or bones. The patient also likely has no symptoms of disease — they don't have blood in their urine or pain, don't need to get up at night to urinate or have particular urinary urgency. But the diagnosis raises everyone's anxiety level even though the clinical reality is that whatever is going on is most likely localized or restricted to the prostate gland and not causing any problems.

In the above situation, which is very common, doctors follow the patient's “low-grade prostate cancer” with active surveillance which involves annual exams and PSA readings. The goal is to ensure that nothing about this slow-growing disease is changing in terms of urinary symptoms and clinical tests.

At a recent international symposium, researchers raised the question as to whether low-grade prostate cancer should even be called cancer. Though it's not normal to have even low-grade prostate cancer, is it really beneficial for the patient if their medical team names it “cancer” since the word cancer carries such a big emotional burden.

In fact, it might help to move away from designating such early signs as cancer. “The word ‘cancer’ has resonated with patients for millennia as a condition associated with metastasis and mortality,” the principal investigator involved with the symposium, Matthew Cooperberg, a faculty member in the Departments of Urology and Epidemiology & Biostatistics at the University of California, San Francisco, believes.

Most men live for years with prostate cancer staying local, as public health statistics document. “We are now finding exceptionally common cellular changes in the prostate that in some cases presage development of aggressive cancer but in most do not. We absolutely need to monitor these abnormalities no matter what we label them, but patients should not be burdened with a cancer diagnosis if what we see has zero capacity to spread or to kill,” Cooperberg added.

The paper, “When is prostate cancer really cancer?” is published in the Journal of the National Cancer Institute.