# Test whether calling Gleason 6 'not cancer' changes what men choose

Source: https://onco.cc/ideas/idea-prev-gleason6-terminology-rct/  
OnCo record `idea-prev-gleason6-terminology-rct` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Gleason 6 prostate lesions do not metastasise. A trial could show whether describing them without the word cancer leads more men to choose monitoring.

## Summary

Survey experiments show terminology shifts preference; no randomised trial has tested it in real diagnoses. Propose a trial embedded in diagnostic clinics: pathology report and consultation script using 'cancer' versus 'indolent lesion of epithelial origin', with active surveillance uptake, anxiety, and two-year treatment as endpoints.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Non-cancer terminology increases active surveillance uptake by at least 10 percentage points and reduces anxiety without reducing adherence to follow-up.
- Rationale: The biology is settled; the behavioural question is testable at low cost.
- Proposed test: 600-man RCT in five centres.
- Maturity: speculative
- Actor: research

## Sources

- Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010): https://doi.org/10.1093/jnci/djq099

## Connected records

- roadmaps: [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/)
- ideas: [Judge a prostate screening programme on metastatic presentation, not on incidence or mortality](https://onco.cc/ideas/idea-prostate-metastatic-presentation-as-the-screening-endpoint/)
- cancers: [Prostate cancer](https://onco.cc/cancers/prostate/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- bottlenecks: [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/), [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/)
- key papers: [Overdiagnosis and overtreatment of prostate cancer](https://onco.cc/key-papers/paper-loeb-overdiagnosis-overtreatment-prostate-eur-urol-2014/), [Overdiagnosis in cancer](https://onco.cc/key-papers/paper-welch-j-natl-cancer-inst/)

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