I believe that cells that meet the definition of cancer should be called cancer... Cancer is cancer.
The question I'm asking is whether a Gleason grade 3 in a low risk setting or perhaps, as some of you suggest, in a very low risk setting (only 1 or 2 positive cores, and less than 50% involvement in them) necessarily qualifies as a "cancer." I am also wondering what is the value and what is the risk of calling it that.
Gleason grade identifies the amount of dysplasia
in the cells, dysplasia meaning relatively undifferentiated, immature cells with disrupted tissue architecture. At its most extreme, Gleason grade 5, the cells exhibit anaplasia
where the cells are undifferentiated and look completely different from healthy prostate cells. When the dysplasia is low grade, as in Gleason grade 1, the cells are almost indistinguishable from healthy prostate cells. There is a continuum of dysplasia rather than discrete categories - the Gleason grades are arbitrary, and pathologists may differ in how they choose to sort what they see under the microscope. In fact, as tarhoosier and JohnT point out, the definitions changed in 2005 (some G3s were re-classified as G4s) and Gleason 1s and 2s are no longer reported as cancers.
Also, is a cell that does not even have the potential
to metastasize really a cancer? Gleason grade 3 seems to lack metastatic potential.
Recent improvements in imaging (mpMRIs, CDUS) are beginning to get us down to the limit of half a cc at which the lesion may be confidently called indolent. Doctors pick that size because that is the size at which men were found to have died with
"prostate cancer" rather then of
it. Risk stratification based on imaging of the lesions rather than just biopsy may help us eliminate unnecessary treatment of men where there is no metastatic potential.
I have held men's hands as they were dying of prostate cancer, because our treatments are just not good enough. I have hugged men who were crying over the distress caused by their treatment for prostate cancer, because our treatments are just not good enough. It breaks my heart when I read stories like cmetalman's who may or may not have been needlessly and perhaps irreparably harmed by his treatment. As I said, cancer is a loaded word, and "cancer panic" is a well-documented phenomenon that occurs when we get a diagnosis with the word cancer
in it. I know it hit me like a ton of bricks. 90% of men react to hearing it by seeking immediate radical treatment. Far from being "malicious," I am looking for a way to do less harm.
I wonder if I were told that I had "some low grade dysplasia
that bears watching or perhaps treatment," instead of being told that I had "prostate cancer that needs treatment," I might have been spared my bout of "cancer panic." I'd like to spare more men the distress that I and so many others have gone through.