Redefining Grade Group 1 Prostate Disease May Reduce Prostate Cancer Deaths: JAMA
USA: Researchers have found in a new study that removing the “cancer” label from Grade Group 1 (GG1) prostate disease and redefining it as a precancerous lesion could lead to an overall reduction in estimated prostate cancer mortality. The authors argue that those favoring retention of the cancer label must demonstrate that relabeling would have little impact on screening behavior or that potential harms outweigh the benefits of reduced prostate cancer deaths.
A brief report published in JAMA Oncology by Andrew J. Vickers and colleagues from Memorial Sloan Kettering Cancer Center explores the potential population-level effects of such a shift in terminology. The proposal to reclassify GG1 prostate cancer as a precancerous condition has been debated widely, particularly due to concerns that it might reduce adherence to active surveillance—an important management strategy for low-risk disease—and thereby increase mortality.
To address these concerns, the research team developed a decision-analytical model to estimate how relabeling GG1 disease might influence prostate cancer deaths in the United States. The model incorporated recent population-based and clinical data from 2020 to 2025, examining two opposing effects: a possible rise in mortality due to reduced compliance with active surveillance, and a potential decline in mortality driven by increased participation in prostate-specific antigen (PSA) screening.
Key Findings:
- The analysis suggested that relabeling GG1 prostate disease could provide greater benefits than risks in terms of mortality outcomes.
- In the base-case scenario, relabeling was associated with nearly six times more prostate cancer deaths prevented than those potentially caused.
- An estimated 2,835 deaths could be avoided annually, compared with approximately 452 additional deaths linked to reduced adherence to monitoring.
- The findings remained robust across multiple alternative modeling scenarios.
- Even under less favorable conditions—such as a 50% rise in disease progression during surveillance, doubled nonadherence rates, and limited increases in screening—the model continued to show a net reduction in mortality.
- In one conservative scenario, the model still estimated close to 500 fewer deaths per year.
- The analysis indicated that even a small absolute increase in screening uptake, as low as 3%, could result in an overall decline in prostate cancer mortality.
The authors highlight that overdiagnosis and overtreatment are key deterrents to PSA screening. By removing the “cancer” label from low-grade disease, patients may be less apprehensive about screening, potentially leading to earlier detection of more aggressive cancers that require timely intervention. This shift could ultimately improve survival outcomes at the population level.
Overall, the study suggests that redefining GG1 prostate disease as a precancerous condition may reduce prostate cancer mortality rather than increase it. The authors emphasize that critics of relabeling need to demonstrate either that such a change would not meaningfully influence screening behavior or that any unintended harms would outweigh the projected reduction in deaths.
Reference:
Vickers AJ, Cooperberg M, Pavlovich CP, Carroll P, Eggener S. Prostate Cancer Mortality After Relabeling Low-Grade Prostate Cancer as Precancerous. JAMA Oncol. Published online May 21, 2026. doi:10.1001/jamaoncol.2026.1391
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