[ISUP 1 Prostate Carcinoma Controversy: Is the Term Carcinoma Justified - Clinical or Anatomical Definition?]

Abstract

The designation of Gleason score 6 (ISUP Grade Group 1) prostate cancer as "cancer" has become increasingly controversial. Despite its excellent prognosis and minimal risk of metastasis, the diagnosis often leads to emotional distress and potential overtreatment. The question of whether a less alarming nomenclature might be more appropriate is gaining relevance. This review analyses the arguments for and against renaming ISUP Grade Group 1 prostate cancer and explains why the definition of indolence cannot be based solely on histological criteria. Drawing on current literature and consensus statements from international pathology societies (ISUP/GUPS), this article critically evaluates pathological, clinical, molecular, and imaging criteria used to define tumour indolence. Neither morphological characteristics, nor molecular markers, nor imaging alone can reliably identify indolent cancers in biopsy specimens. Diagnostic uncertainty is further amplified by significant interobserver variability. Multidisciplinary approaches that integrate clinical, radiological, molecular, and histopathological parameters appear necessary to accurately detect and classify indolent tumours. Simply renaming GG1 prostate cancer using a less threatening term is insufficient. Instead, individualised, multidimensional risk stratification is essential. The debate underscores that the responsibility for defining indolent prostate cancer cannot rest solely with pathology.