The problem of overtreatment of prostate cancer is well-known.  Many invasive, aggressive treatments are performed on men whose cancer would never pose a threat to their lives anyway.  And they are often left with nasty side effects, physical and emotional.  So a well-known PC pathologist, Dr. Jonathan Oppenheimer, proposes a solution:  Let’s call the low-grade tumors something other than “cancer”.  That’s because cancer universally invokes dread in people, and they naturally do not want to leave it untended.  Dr. Oppenheimer suggests using the less threatening “prostatic tubular neogenesis”.  Maybe if people hear this from their doctors rather than the dreaded “C-word” they will be able to take a step back and think about more gentle treatments for PC that might work for them

I think it’s a great idea!

Here are some excerpts from Dr. Oppenheimer’s opinion:

(For full text go to http://theprostateblog.blogspot.com (Feb 2008))

Prostatic Tubular Neogenesis– A Letter to Colleagues

 The most common significant finding made by contemporary pathologists on prostate biopsies cannot be adequately described by “tumor” (Greek: swelling), “cancer” (from the crab-like extension), or “malignant” (threatening to life or tending to metastasize). I propose the terms “prostatic tubular neogenesis” (creation of new epithelial tubes or acini) and “potentially malignant” to better describe the microscopic findings that we have in the past labeled “adenocarcinoma” “cancer” “tumor” and “malignant.”

Criteria are evolving that allow for the active surveillance of the common microscopic neoplastic findings we identify. As these histological criteria …. and increasingly molecular criteria …evolve, we will better define which of our findings are potentially life threatening and which are indolent.

I suggest that the terms “cancer,” “adenocarcinoma,” “malignancy,” and “tumor” be avoided by on pathology reports unless there exists clear evidence of Gleason pattern 4, more than two cores are involved, or if total lesion length is more than 3mm. The term “tubular neogenesis” followed by an explanation, can better serve the discussion between physician and patient that must follow. As our understanding evolves, criteria for identifying life-threatening prostatic alterations on needle core biopsies in conjuction with serological or urine-based molecular assays, or new non-invasing imaging techniques will allow the more aggressive terms to be used without fear of inducing unnecessary medical intervention.

. In the meantime, let us see that our diagnoses are placed in context so that we are not accomplices in advising therapies that are worse than the disease.

Primum non nocere.  [First, do no harm?]