HQ Team
August 2, 2025: A study published in JAMA Oncology is challenging the conventional belief that men diagnosed with Grade Group One (GG1) prostate cancer are at low risk and can safely opt for “watchful waiting” instead of immediate treatment.
The research, led by Weill Cornell Medicine, University Hospitals Cleveland, and Case Western University, suggests that up to 30% of these cases may actually harbor higher risks than biopsy results alone indicate.
The Study’s Findings
The study analyzed data from over 300,000 men diagnosed with prostate cancer that had not spread beyond the prostate gland. Among these, approximately 117,000 were classified as having GG1 tumours based on initial biopsy results. However, when researchers incorporated additional clinical factors such as prostate-specific antigen (PSA) levels and tumour size, they discovered that more than 18,000 of these men actually had higher-risk cancers that would typically warrant treatment with radiation therapy or radical prostatectomy.
Implications for Treatment
Dr. Bashir Al Hussein, co-senior author of the study and assistant professor of urology at Weill Cornell Medicine, emphasized the importance of not underestimating risk: “We don’t want to miss aggressive cancers that initially present as Grade Group One on biopsy,” he said. “Such underestimation of risk could lead to undertreatment and poor outcomes.”
The Debate Over GG1 Classification
The findings come at a time when some experts have advocated for removing the “cancer” label from GG1 tumours altogether, arguing that most GG1 cancers are slow-growing and rarely cause harm. However, Dr. Jonathan Shoag, another co-senior author of the study, warned against this approach: “There is a misunderstanding that ‘low grade’ and ‘low risk’ are the same. Here, we show clearly that they are not,” he said. “Attempts to rename GG1 are misguided as many patients with GG1 cancers on biopsy have substantial risks of their cancers causing pain and suffering over their lifetime if untreated.”
Moving Forward
The study highlights the need for a more nuanced approach to diagnosing and treating GG1 prostate cancer. Dr. Al Hussein stressed the importance of educating patients about their prognosis and helping them understand the full scope of their diagnosis. “We need to find a better way to inform patients about their prognosis when they have GG1 prostate cancer with adverse clinical features,” he said. “As physicians, the responsibility falls on us to provide them with the information they need to understand their diagnosis and decide on the best approach for treatment, while continuing to advocate for active surveillance for those who are indeed low risk.”
This new research underscores the complexity of prostate cancer diagnosis and the limitations of relying solely on biopsy results. It calls for a more comprehensive evaluation that considers multiple clinical factors to ensure that patients receive the most appropriate care.
