Prostate cancer (PC) is a major cause of cancer-related deaths worldwide, with far more diagnoses than deaths annually. Recent discussions have challenged whether Grade Group 1 (GG1) PC should be labeled "cancer" due to its indolent nature. To address this question, an international symposium convened stakeholders from various fields. We summarize key discussion points: autopsy studies reveal GG1 is so common in aging males as to be perhaps a normal aspect of aging. Pure GG1 has no capacity to metastasize. Modern diagnostic pathways focus on detecting higher-grade disease, explicitly omitting biopsy if GG 2 or higher is not suspected, so GG1 has effectively become an "incidentaloma." Recent spatial transcriptomics of prostate sections identifies a continuum of genomic changes-including alterations characteristic of malignancy in histologically normal regions, so the designation of cancer based entirely on conventional pathology findings increasingly seems arbitrary at least to an extent. Pathologists discussed heterogeneity and diagnostic challenges, suggesting "acinar neoplasm" as one possible alternative label. GG1 should not be considered "normal," and absolutely requires ongoing active surveillance; whether patients would adhere to surveillance absent a cancer diagnosis is unknown. Patient perspectives highlighted the adverse effects of overtreatment and the burden of a cancer diagnosis. The anticipated impact on screening and treatment varies across health-care systems, but many believe public health would on balance greatly improve if GG1-along with lesions in other organs with no capacity to cause symptoms or threaten life-were labeled something other than "cancer." Ultimately, our goal is to reduce PC mortality while minimizing harms associated with both overdiagnosis and overtreatment.

中文翻译：

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前列腺癌什么时候是真正的癌症？


前列腺癌 （PC） 是全球癌症相关死亡的主要原因，每年的诊断人数远多于死亡人数。最近的讨论对 1 级 （GG1） PC 是否应该因其惰性而被贴上“癌症”的标签提出了挑战。为了解决这个问题，来自各个领域的利益相关者召开了一次国际研讨会。我们总结了关键讨论点：尸检研究表明 GG1 在老年男性中非常常见，以至于可能是衰老的正常方面。纯 GG1 没有转移能力。现代诊断途径侧重于检测更高级别的疾病，如果不怀疑 GG 2 或更高级别，则明确省略活检，因此 GG1 实际上已成为“偶发瘤”。最近的前列腺切片空间转录组学确定了基因组变化的连续体——包括组织学正常区域的恶性肿瘤特征改变，因此完全基于常规病理学发现的癌症命名至少在某种程度上越来越显得武断。病理学家讨论了异质性和诊断挑战，建议将“腺泡肿瘤”作为一种可能的替代标签。GG1 不应被视为“正常”，绝对需要持续的主动监测;目前尚不清楚患者在没有癌症诊断的情况下是否会坚持监测。患者观点强调了过度治疗的不利影响和癌症诊断的负担。对筛查和治疗的预期影响因医疗保健系统而异，但许多人认为，如果 GG1 以及其他器官中无法引起症状或威胁生命的病变被贴上“癌症”以外的标签，那么总体上公共卫生将大大改善。“ 最终，我们的目标是降低 PC 死亡率，同时最大限度地减少与过度诊断和过度治疗相关的危害。