Before this study, there was a quiet gap on the kitchen counter: everyone could argue about whether low-grade prostate cancer should still be called “cancer,” but nobody had really measured what might happen to deaths if we changed the label on the jar.
That label matters. A lot.
The paper in JAMA Oncology asks a deceptively simple question: if Grade Group 1 prostate cancer - also called Gleason 3+3 or Gleason 6 - were renamed as a precancerous condition, would that save lives or accidentally burn the whole casserole? The worry is obvious. If you tell someone, “This is not cancer,” maybe they stop showing up for active surveillance, which is the medical version of keeping the soup on low heat and checking it often so it does not boil over.
But the authors modeled the other side of the kitchen too: what if removing the scary word “cancer” made more men willing to get PSA screening in the first place?
The Word on the Label Can Change the Whole Meal
Grade Group 1 prostate disease is the lowest-grade category. Under the microscope, the cells still look pretty organized, like a recipe that got a little smudged but has not turned into “throw the pan away and order pizza.” The problem is that prostate screening can find a lot of these low-grade spots, and once the word “cancer” appears, people understandably want action.
And by action, medicine often means surgery or radiation. Those treatments can help when the disease is dangerous, but for very low-risk prostate cancer, they may also bring side effects without much benefit. That is the overdiagnosis and overtreatment problem: we find something that may never hurt someone, then serve a treatment course nobody actually needed.
Active surveillance tries to fix that. Instead of immediate treatment, doctors monitor PSA, exams, imaging, and sometimes repeat biopsies. It is not “ignore it and hope.” It is more like checking the bread every few minutes because nobody wants a charcoal loaf.
The Model’s Kitchen Math
Vickers and colleagues built a decision model using US data from 2020 to 2025. They compared two possible effects of relabeling Grade Group 1 as precancerous.
First, the bad possibility: some men might take surveillance less seriously, allowing more dangerous disease to be missed or treated late.
Second, the good possibility: more men might accept PSA screening because they are less afraid of being diagnosed with a low-grade “cancer” that leads to anxiety or unnecessary treatment.
In their base case, relabeling was estimated to prevent 2,835 prostate cancer deaths per year through increased screening, while causing 452 deaths through reduced surveillance adherence. That is not a tiny garnish. That is a six-to-one difference. Even in tougher scenarios, the model still usually favored relabeling. In the base case, screening rates only had to rise by about 3 percentage points for the mortality math to come out ahead.
Of course, a model is not a crystal ball. It is a carefully labeled pantry of assumptions. Change the ingredients and the flavor changes. But the authors tested many variations, including worse surveillance adherence and higher progression rates, and the main result held up.
Why This Debate Gets So Steamy
The disagreement is not silly. Both sides have real concerns.
Supporters of renaming argue that pure Grade Group 1 behaves very differently from aggressive prostate cancer. Calling it cancer may push patients toward treatment they do not need, along with urinary, sexual, and bowel side effects. Prior authors have argued that low-grade prostate cancer is a prime candidate for a naming rethink, especially because the cancer label can turn a small simmer into a full emotional kitchen fire Eggener et al., 2022.
Critics counter that biopsies can miss higher-grade disease. A spoonful from the stew is not the whole pot. If Grade Group 1 is found on biopsy, there could still be a hotter patch elsewhere in the prostate. Pathologists and clinicians have warned that any renaming must protect careful follow-up and avoid giving patients a false “nothing to see here” message van Leenders et al., 2023.
That is where active surveillance remains the recipe card taped to the fridge. Renaming should not mean walking away from monitoring. It should mean using a better label while still checking whether the dish changes.
The Bigger Point: Screening Has a Reputation Problem
PSA screening has always been a complicated menu item. It can catch dangerous cancers earlier, but it can also find low-risk disease that might never cause symptoms. The ProtecT trial showed that, after 15 years, prostate cancer death rates were low across monitoring, surgery, and radiotherapy groups, though metastases and progression differed Hamdy et al., 2023. Translation: some prostate cancers simmer for a long time, but not all pots behave the same.
That is why this new study is interesting. It suggests the label itself may influence the whole screening ecosystem. If men believe screening means they might be handed a terrifying diagnosis and rushed toward treatment, they may skip screening altogether. But if low-grade findings are described more accurately, maybe more men enter the kitchen early enough for doctors to catch the truly dangerous recipes.
Not “No Big Deal,” But Maybe “Different Deal”
The best takeaway is not that Grade Group 1 should be ignored. Please do not toss the timer in the sink. The takeaway is that words in medicine act like ingredients. Too much fear can spoil the dish. Too little caution can undercook it.
If future studies confirm this model, relabeling Grade Group 1 as precancerous could reduce overtreatment, lower anxiety, and make PSA screening feel less like opening a mystery casserole labeled “doom.” But the follow-up system would need to be clear, reliable, and easy to stick with.
A better name will not fix everything. But sometimes changing the label on the jar helps people use the ingredient correctly.
References
Vickers AJ, Cooperberg M, Pavlovich CP, Carroll P, Eggener S. Prostate Cancer Mortality After Relabeling Low-Grade Prostate Cancer as Precancerous. JAMA Oncology. Published online May 21, 2026. https://doi.org/10.1001/jamaoncol.2026.1391
Eggener SE, Berlin A, Vickers AJ, et al. Low-Grade Prostate Cancer: Time to Stop Calling It Cancer. Journal of Clinical Oncology. 2022. https://doi.org/10.1200/JCO.22.00123
Zhao Y, Gulati R, Yang Z, et al. Projected outcomes of reduced-biopsy management of Grade Group 1 prostate cancer: implications for relabeling. Journal of the National Cancer Institute. 2025;117(4):685-691. https://doi.org/10.1093/jnci/djae296
Hamdy FC, Donovan JL, Lane JA, et al. Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. New England Journal of Medicine. 2023;388:1547-1558. https://doi.org/10.1056/NEJMoa2214122
Disclaimer: The image accompanying this article is for illustrative purposes only and does not depict actual experimental results, data, or biological mechanisms.