Did you ever have a lazy day when you just wanted to lie around doing nothing? If so, did you give in to allure of idleness? The words “lazy” and “idle” have negative overtones. They are associated with lack of ambition (lazybones), messiness (lazy slob), and even absence of moral fiber (an idle mind is the devil’s playground). However, there’s another word that actually has a positive medical meaning: indolent.

Indolent prostate cancer

A paper published in the Jan. 17, 2025 issue of the Journal of the American Medical Association (JAMA) describes indolent tumors as “asymptomatic lesions unlikely to progress for years”. In other words, indolent prostate cancer (PCa) tumors lie around in an idle state. For years, they give no warning signs like blood in urine or bone pain. Therefore, they remain undetected unless routine screening is done. Because of this, indolent PCa has been described by a growing number of experts as a cancer that doesn’t behave like a cancer. If that is so, what should it be called?

Relabel indolent PCa?

The JAMA paper referenced a 2012 conference hosted by the National Cancer Institute to address how to label indolent tumors—not just prostate cancer, but also breast cancer. It’s not unusual for screening programs like PSA tests and mammograms to detect idle masses that set off a panic button. When this happens, indolent tumors are literally attacked harshly: invasive surgery or high doses of radiation. In turn, many patients are left with side effects that can have a domino effect: more appointments, more treatments, stress, reduced quality of life, etc. As author Rita Rubin, MA writes:

The meeting participants’ first recommendation was to remove the word cancer from the names of tumors unlikely to become a problem. Instead, the participants urged, the tumors should be classified as indolent lesions of epithelial origin, or IDLEs. Their reasoning? The word cancer generates fear and anxiety, which leads to overtreatment of tumors that are almost never associated with invasion and disease progression.^[i]

She states that Gleason 6 PCa is still called cancer, “… even though the authors of a recent article noted that it ‘is so highly prevalent it might be considered a normal feature of aging.’” Another way to categorize Gleason 6 (Gleason 3+3) PCa is the new Grade Group system. I describe it like this:

• Grade 1 – Most prostate cells appear organized and normal, some are unusual = low/very low risk
• Grade 2 – Space develops between the healthy cells with more abnormal cells = favorable intermediate risk
• Grade 3 – Small clumps of early cancer cells are infiltrating and disorganizing the spaces = unfavorable intermediate risk
• Grade 4 – Irregular masses of cancer cells are taking over, with few healthy cells present = high risk
• Grade 5 – Complete disorganization, with sheets of cancer cells = very high risk

Consequence of relabeling Grade 1 PCa

One expert, Dr. Laurence Klotz, has maintained that Grade Group 1 PCa (Gleason 3+3), in itself, has never been proven to metastasize. According to him, the molecular genetics most Gleason 3+3 are normal.^[ii] On the other hand, other experts worry that if we stop calling it cancer, patients will neglect getting the monitoring and/or treatment they need, and eventually their PCa may progress beyond hope of cure and they end up dying of their disease. This would indeed be a tragic consequence.

However, the Rubin article cites expert agreement that “… no matter what low-risk tumors are called, patients in whom they’re detected need better information about their diagnosis before deciding how to proceed.” At our own Center, we agree—and that’s exactly what our excellent services are here for.

Thanks to our 3T multiparametric MRI, and our real-time MRI-guided targeted biopsy, we equip each individual with essential information. First, with imaging, biopsy, and genomic analysis as indicated, we provide detailed, accurate information about his clinical factors. Knowledge is empowering, and we assist patients in matching treatment choices to their disease for best likelihood of success while preserving quality of life.

Second, we offer clinical PCa management second to none when it comes to minimal to noninvasive therapies. If the patient is qualified for Active Surveillance and is motivated to hold off on treatment, our monitoring/surveillance protocols are so sensitive that any change in tumor activity is quickly detected and addressed. Or, for those patients who feel more comfortable with treating their disease but want to avoid overtreatment/side effect risks, we offer MRI-guided focal therapy choices: Focal Laser Ablation, TULSA, and Exablate MRI-guided Focused Ultrasound.

For us, the bottom line is not about labels, it’s about precisely identifying the disease—regardless of Gleason grade—and the optimal way to treat it. To paraphrase Shakespeare, a prostate cancer by any other name still deserves the best clinical care. It’s our goal to provide it.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Rubin R. Experts Are Debating Whether Some Cancers Shouldn’t Be Called That. JAMA. Published online January 17, 2025.
[ii] Klotz, L. “Active Surveillance: Who is the Right Patient and What is the Right Protocol?” Grand Rounds Urology, Mar. 2017. https://grandroundsinurology.com/active-surveillance-right-patient-right-protocol/