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Experts disagree on whether prostate cancer with a Gleason score of 6 (GS6) should be re-labeled as non-cancerous.

Writing in a commentary in the , Scott Eggener, MD, and colleagues argue that GS6 behaves like pre-cancer, not cancer, and that reclassification will thus dramatically reduce overdiagnosis and overtreatment, lessening healthcare costs, and minimizing patient anxiety. Opponents argue that GS6 is still cancer, histologically and molecularly, and that substantial numbers of patients are found to have higher-grade cancer on subsequent examinations.

In the following interview, Eggener, director of the High Risk and Advanced Prostate Cancer Clinic at the University of Chicago, delves into these arguments and issues.

What is the strongest argument for re-labeling GS6 as non-cancerous, if you had to pick one?

Eggener: Many prostate cancer specialists feel [that with such a change] public health would be significantly improved with far more expected benefit than potential harm. GS6 behaves as non-cancerous as it cannot cause symptoms or metastasize to other parts of the body. As a very common diagnosis, it causes a tremendous amount of anxiety, procedures, cost, and follow-up -- all for questionable benefit. It often leads to treatment with surgery or radiation, each of which have the potential for life-long side effects, all for questionable, if any, benefit.

What do you think is the strongest argument on the other side for not making this change?

Eggener: If it were given a "pre-cancerous" label, the potential that men would be less likely to follow up with their physicians. Counter-point: We have tens of millions of men in the United States who follow up for their elevated PSA, previously negative prostate biopsies, or on active surveillance. Similarly, it would be important for urologists to share the importance of follow-up, and ultimately it is up to the man to follow up, as it is for virtually every other medical situation (high blood pressure, colon polyps, etc).

How does GS6 behave clinically like pre-cancer rather than cancer?

Eggener: Similar to pre-cancerous or benign lesions of the prostate, Gleason 6 is incapable of causing symptoms or spreading to other parts of the body (metastasizing). The Merriam-Webster dictionary definition of benign is "of a mild type or character that does not threaten health or life." Gleason 6 meets that definition.

What else would you like to make sure oncologists understand about this issue?

Eggener: It's an important discussion to have amongst the prostate cancer community, physicians, patients, advocates, etc.

What would it take to settle this issue for good?

Eggener: No clue, but it starts with a discussion, evidence-based argument, and eventually collaborative input between clinicians and pathologists to consider a formal name change.

Read the commentary here.