What is the Gleason 6 Type in Prostate Cancer?

At the first ever Active Surveillance Convention, a conference I attended back in 2007, many experts openly bemoaned that the word “CANCER” profoundly overstates the significance of Gleason 6 type of prostate cancer. The pathologists at the conference, however, shot down the idea of a name change saying, “Under the microscope it looks like a cancer, so it is cancer.” No one at the conference had  a rebuttal so the proposal for a name change was dropped.

In retrospect, I wish the conference attendees had been able to rise up to the challenge and change the name to something less threatening. Back when the makers of Seven-Up wanted to emphasize the distinctness of their product from other soft drinks, they came up with the name “Un-Cola,” a stroke of marketing genius. Since the pathology experts insist that low risk disease is a cancer, I would like to propose that we undo the negativity of this word by renaming it: “The Un-Cancer.” 

The word “CANCER” leads everyone to think, “I better be safe and remove the gland.”  Overcoming preconceived notions is one of the most challenging aspects of human behavior. It’s easier to teach a proper golf swing to a true beginner than to someone with ingrained bad habits. Children learn a new language so much more easily than adults.  So “un-doing” what men think they know about prostate cancer is probably the biggest challenge I face seeing patients in my day to day practice.

Some hear that “you die with it, not from it.”  But that sounds nonsensical when you consider another true statistic—that prostate cancer is the second most common cause of death from cancer in men. 

Since so many men are dying but a vastly larger amount of men live out normal life expectancies and die of other causes, there can be only one reasonable conclusion. What we call “prostate cancer” is simply an umbrella term for two distinctly different conditions. The concept of having multiple types of cancer originating in one organ is not unique.  Take skin cancer, for example, of which there are three types: basal cell, squamous cell and melanoma.  The basal cell and squamous cell types are harmless (like some forms of prostate cancer are harmless) while the melanoma type of skin cancer is deadly (as can be the case for some types of prostate cancer). Yet all three types are considered types of skin cancer. 

Withholding treatment from anything called cancer is psychologically challenging, especially if charismatic medical experts, surgeons and radiation therapists are eagerly pushing for therapy.  So, to bolster the argument for monitoring, let’s try to better characterize this grab bag term “prostate cancer” by examining some statistics and comparing them with colon cancer, a more typical cancer that has death rates almost on par with prostate cancer (See Table 1).

So men diagnosed with prostate cancer are three times less likely to die. And if they do die, death occurs twelve times more slowly.  Almost all cancers—lung, pancreas, stomach, gallbladder, kidney, brain, bone, etc., behave more like colon cancer rather than prostate cancer. So it’s totally logical for uninformed people who are more likely to be familiar with all these other cancers to be terrified by anything termed “CANCER.” 

Changing the name of low grade prostate cancer to something else would go a long way toward reducing the treatment excesses that are careening out of control.  As long as we keep calling it “CANCER” patients and doctors are going to assume having immediate radical treatment is the most prudent approach. 

Article originally posted October 23, 2012, on the Prostate Snatchers blog, by Mark Scholz, MD

More about Dr. Scholz:

A board-certified medical oncologist, Mark C. Scholz, MD, serves as medical director of Prostate Oncology Specialists Inc. in Marina del Rey, CA, a medical practice exclusively focused on prostate cancer. He is also the Executive Director of the Prostate Cancer Research Institute. He received his medical degree from Creighton University in Omaha, NE. Dr. Scholz completed his Internal Medicine internship and Medical Oncology fellowship at University of Southern California Medical Center. He is the co-author of the book Invasion of the Prostate Snatchers: No More Unnecessary Biopsies, Radical Treatment or Loss of Potency.  He is a strong advocate for patient empowerment.