Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA.
Department of Pathology, Warren Alpert Medical School of Brown University, Providence, RI.
Urol Oncol. 2023 Feb;41(2):62-64. doi: 10.1016/j.urolonc.2022.09.028. Epub 2022 Nov 23.
Overdiagnosis and overtreatment of Grade Group 1 (GG 1) prostate cancer remains a significant health care problem despite of its improved risk assessment and uptake in conservative management. Removing the cancer label from these non-lethal cancers has been proposed as an expedient way to reduce potential physical, psychological and financial harm to patients. Such a nomenclatural change necessitates a multidisciplinary team effort by clinicians and pathologists. Genitourinary Pathology Society recently conducted a survey of its members, gauging their awareness of this controversy and their position on whether GG 1 prostate cancer should be reclassified. Most respondents (196, 81.7%) opposed removing the cancer label from GG 1 cancer, 33 (13.8%) supported a change in nomenclature, while 11 (4.6%) responded that they were uncertain. Of those who supported the reclassification, 17 (51.5%) supported the change for radical prostatectomy only, 4 (12.1%) for biopsy only, and 12 (36.4%) for both biopsy and radical prostatectomy. This survey results highlight the gap between pathologists and clinicians in whether GG 1 prostate cancer should be labeled as "non-cancer," and calls for continued debates and conversations between pathologists and clinicians, and further studies on the biology, diagnostic reproducibility, and ideal management of GG 1 prostate cancer in order to make a more evidence-based decision for patients.
尽管对 GG1 前列腺癌的风险评估有所改善，并采用了更保守的管理方法，但这种癌症的过度诊断和过度治疗仍然是一个严重的医疗保健问题。有人提议，将这些非致命性癌症从癌症标签中去除，以减少对患者身体、心理和经济方面的潜在伤害。这种命名上的改变需要临床医生和病理学家的多学科团队努力。泌尿生殖系统病理学学会最近对其成员进行了一项调查，了解他们对这一争议的认识，以及他们对 GG1 前列腺癌是否应重新分类的立场。大多数受访者（196 人，占 81.7%）反对从 GG1 癌症中去除癌症标签，33 人（占 13.8%）支持改变命名，11 人（占 4.6%）表示不确定。在支持重新分类的人中，17 人（占 51.5%）仅支持对根治性前列腺切除术进行分类，4 人（占 12.1%）仅支持对活检进行分类，12 人（占 36.4%）支持对活检和根治性前列腺切除术都进行分类。这项调查结果突出了病理学家和临床医生之间在 GG1 前列腺癌是否应被标记为“非癌性”的问题上存在分歧，并呼吁病理学家和临床医生之间继续进行辩论和对话，进一步研究 GG1 前列腺癌的生物学、诊断可重复性以及理想的管理方法，以便为患者做出更基于证据的决策。
