“Don’t worry about Gleason 3+3=6 (Grade Group 1)! It’s harmless! In fact, we shouldn’t even call it cancer!” Many patients have heard reassurances like these, and yes, if you have to have prostate cancer, Grade Group 1 is the best kind to have. 
But wait: Let’s not call it “not cancer,” says Jonathan Epstein, M.D., the Rose-Lee and Keith Reinhard Professor of Urologic Pathology. “There are some very good reasons to keep the cancer designation for Grade Group 1.” Epstein should know; he is the renowned pathologist who came up with the Grade Group system of prostate cancer grading, a system that has been adopted worldwide. 

“Under the microscope,” he explains, “Grade Group 1 cancer has some of the same behaviors as higher-grade cancer. It’s invasive, and it can appear in perineural invasion and extra prostatic extension,” cancer that has spread beyond the prostate but is still curable. “Molecularly, it has many of the hallmarks of prostate cancer, as well.” 

Another problem: many men who are diagnosed with Grade Group 1 cancer on biopsy turn out to have higher-grade cancer in their prostate, found at radical prostatectomy. “It was just missed during the biopsy.” 

Epstein worries that if men believe they don’t have cancer, they won’t feel a strong need to get regular follow-up monitoring. “They may think, ‘My doctor said it’s not cancer, so why do I have to keep coming back?’” And yet, he warns: “The excellent prognosis of treated Grade Group 1 cancer is not the same if it is called noncancer and is not treated.” 

A name change may not even be that meaningful today, Epstein continues. “Grade Group 1 is more intuitive to patients as lowest-grade cancer. With greater acceptance of active surveillance, patients are understanding that not all cancers are the same, that not everyone needs treatment right away – or ever – and that low-grade cancer can be followed carefully and safely.”