Should Low-Grade GG1 Prostate Changes Be Called Cancer?

Author: Oxford University Press USA
Published: 1 Oct 2024 - Updated: 27 Oct 2026
Publication Details: Peer-Reviewed | Data & Statistical Analysis

Table of Contents:
Synopsis - Definition - Overview - FAQs - Insights, Updates - Related Content

Synopsis

This research reports on a peer-reviewed paper in the Journal of the National Cancer Institute that asks whether Grade Group 1 (GG1) prostate abnormalities, the lowest-risk form of what is now labeled prostate cancer, should keep the cancer name at all. The authors drew on an international symposium that brought together clinicians, pathologists, researchers and patient advocates, led by principal investigator Matthew Cooperberg, to weigh the psychological weight of a cancer diagnosis and the physical harms of surgery or radiation against the risk that patients might skip follow-up if the word cancer were dropped. The main finding is a call to rethink the label while keeping active monitoring firmly in place, since GG1 almost never spreads or causes symptoms. For men facing a prostate biopsy result, and particularly for older men and those already managing disability or chronic illness, where unnecessary treatment can mean incontinence, erectile dysfunction and added strain, the discussion offers useful context for asking informed questions about surveillance versus treatment.*

At a Glance

• 1 - GG1 lesions turn up at very high rates in autopsy studies of men who died of unrelated causes.
• 2 - Symposium participants stressed that GG1 is common in older men but should not be treated as normal.
• 3 - Prostate cancer caused about 400,000 deaths worldwide in 2022, compared with nearly 1.5 million new diagnoses.
• 4 - Modern diagnostic tools are increasingly geared toward finding higher-grade cancers, which makes the label for GG1 a growing question.

Topic Definition

Grade Group 1 Prostate Cancer

Grade Group 1 (GG1) prostate cancer is the lowest category in the five-tier grading system used by pathologists to describe prostate tumors under the microscope, equivalent to a Gleason score of 6 (3+3). Cells in GG1 lesions look only mildly abnormal and are well organized into glands, and the condition very rarely grows quickly, spreads beyond the prostate or causes death. Because of this low risk, most major guidelines recommend active surveillance - scheduled PSA blood tests, imaging and periodic biopsies - rather than immediate surgery or radiation, and some experts now argue that GG1 should be given a non-cancer name to reduce overtreatment and the emotional burden of a cancer diagnosis.

Overview

When is Prostate Cancer Really Cancer?

A new paper in the Journal of the National Cancer Institute, published by Oxford University Press, indicates that patients may benefit if doctors stop calling certain early-stage changes to the prostate "cancer" at all.

Worldwide, Prostate cancer ranks second in diagnoses but fifth in deaths. but far more patients are diagnosed than die of the disease. In 2022, there were nearly 1.5 million cases of prostate cancer, but only 400,000 deaths. Low-grade prostate cancer, commonly known as GG1 among physicians, virtually never metastasizes or causes symptoms. Some medical researchers have wondered recently if it would be a benefit to public health to call GG1 something other than cancer.

To further this discussion, researchers convened an international symposium with participants from multiple fields, including patient advocacy. Key considerations included the very high rate of GG1 detectable on autopsy studies, the focus of contemporary diagnostic tests on detecting higher grade cancers, the benefits of relegating GG1 to something more like "incidentaloma" status, the adverse health effects of overtreatment, and the psychological burden of a cancer diagnosis for patients.

Those who convened at the meeting emphasized that while GG1 is common among older men, it should not be considered normal. Patients with this condition should continue to monitor it with their physicians, according to investigators.

One concern is that patients may not bother to monitor the progression of the condition if their doctor doesn't use the word "cancer" to explain what's going on. Ultimately, those involved in the discussion emphasized, the goal of prostate cancer screening, diagnosis, and treatment is to bring down mortality rates while also reducing the harms of overdiagnosis and overtreatment. Matthew Cooperberg, the principal investigator involved with the symposium, believes that a reconsideration of nomenclature may be a good way to help bring this about.

"The word 'cancer' has resonated with patients for millennia as a condition associated with metastasis and mortality," explained Cooperberg. "We are now finding exceptionally common cellular changes in the prostate that in some cases presage development of aggressive cancer but in most do not. We absolutely need to monitor these abnormalities no matter what we label them, but patients should not be burdened with a cancer diagnosis if what we see has zero capacity to spread or to kill."

More on this topic: Prostate Cancer Publications - Men's Health Publications - Cancer Treatment Publications

Frequently Asked Questions

NOTE: Researched FAQs by Disabled World (DW)

What is the difference between a Gleason score and a grade group?

The Gleason score adds together the two most common cell patterns seen in a biopsy, while the grade group system simplifies those scores into five categories from 1 to 5. A Gleason score of 6 corresponds to Grade Group 1, the lowest risk level.

What does active surveillance for low-grade prostate cancer involve?

Active surveillance usually includes PSA blood tests every few months, periodic prostate MRI scans and repeat biopsies at set intervals. Treatment is offered only if tests show the disease is growing or becoming more aggressive.

Can GG1 prostate abnormalities turn into aggressive cancer later?

Most GG1 findings stay stable for many years, but a small share of men are later found to have higher-grade disease. This is often because a more aggressive area was missed in the first biopsy, which is why ongoing monitoring remains important.

What are the common side effects of treating low-risk prostate cancer?

Surgery and radiation can lead to urinary incontinence, erectile dysfunction and bowel problems. For men with low-risk disease these side effects may outweigh any benefit, which is a major reason doctors often recommend monitoring first.

Has cancer terminology been changed for other low-risk conditions before?

Yes, a low-risk thyroid tumor was renamed in 2016 as noninvasive follicular thyroid neoplasm with papillary-like nuclear features to avoid labeling it as cancer. Similar debates continue for some early breast changes such as ductal carcinoma in situ.

Would renaming GG1 affect insurance coverage for monitoring?

Coverage rules vary by insurer and country, and a name change could affect how follow-up tests are coded and billed. Patients should confirm with their insurer that PSA testing, MRI and biopsies remain covered under any new terminology.

Should men still get PSA screening if most low-grade findings are harmless?

Screening decisions are best made with a doctor based on age, family history, ethnicity and personal preferences. Screening still helps find higher-grade cancers early, when they are most treatable, even though it also detects many low-risk lesions.

What questions should I ask my doctor after a GG1 diagnosis?

Useful questions include how much of the biopsy showed abnormal cells, whether an MRI has been done, what the monitoring schedule will be and what changes would prompt treatment. Asking for a second opinion on the pathology is also common and reasonable.

Insights, Analysis, and Developments

Editorial Note: The debate over GG1 is less about semantics than about what a single word sets in motion. A cancer label can push men toward prostatectomy or radiation for a lesion that, in nearly every case, would never have threatened their lives, while also bringing anxiety, insurance complications and a lasting sense of being a cancer patient. At the same time, the gap between roughly 1.5 million annual diagnoses and about 400,000 deaths shows how much of the screening burden falls on men with low-risk disease. Any renaming would need to be paired with clear surveillance guidance - regular PSA testing, MRI and repeat biopsy where warranted - so that the small share of GG1 findings that do progress are still caught early. For older men, and for those whose disability or other health conditions already make surgery riskier, a more accurate label could make the case for watchful monitoring easier to accept and to discuss with family and physicians.*

Attribution/Source(s): This peer-reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally issued as a press release by Oxford University Press USA and published on 1 Oct 2024. Last updated on 27 Oct 2026. This content may have been edited for style, clarity, or brevity.

* Editorial additions by Ian C. Langtree.