Calling the lowest-risk prostate cancers something else may encourage some patients to follow physicians' treatment recommendations of active surveillance and avoid pursuing more aggressive options, according to a growing number of physicians advocating for a change in nomenclature, The Wall Street Journal reported Jan. 24.
"The word 'cancer' engenders so much anxiety and fear," Laura Esserman, MD, a professor of surgery and radiology at the University of California in San Francisco and director of its breast care center, told the news outlet. "Patients think if I don't do something tomorrow, this is going to kill me. In fact, that's not true."
There are five grade groups of prostate cancer — the most common cancer among men in the U.S. — with 1 representing the lowest risk and 5 the highest. Physicians typically recommend careful monitoring for low-risk cancers, which account for around one-quarter of men diagnosed with prostate cancer, according to experts who spoke to the Journal. Surgery or radiation are typically part of the recommended treatment for moderate and high-risk cancers.
While evidence demonstrates active surveillance is an effective way to manage low-grade prostate cancer, around 40% of men with a lower-grade diagnosis choose more aggressive treatment options.
"They look at me and say, 'I have cancer, it has to be treated,'" David Penson, MD, professor and chair of the urology department at Nashville, Tenn.-based Vanderbilt University Medical Center, told the Journal, adding that about 1 in 5 of his patients with low-grade cancer insist on surgery or radiation.
"If you make that sort of nomenclature change, people may be more open to the idea of accepting active surveillance," he said.
With low-grade prostate cancers, physicians have proposed referring to it as a premalignant lesion instead.
When choosing active surveillance, it is critical patients stick with follow-up visits, since some lower-grade cancers do turn into more aggressive types. This is one reason why some physicians are in favor of sticking with the "cancer" name. For instance, more than 40% of men who choose active surveillance already have poor follow-up. Some experts worry that calling it something other than cancer would push that rate up even higher. Instead, some argue physicians invest more effort in educating patients about what low-grade cancer means and the efficacy of active surveillance.