{"entity":{"id":"idea-prev-gleason6-terminology-rct","kind":"idea","name":"Test whether calling Gleason 6 'not cancer' changes what men choose","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010)","url":"https://doi.org/10.1093/jnci/djq099"}],"tags":[],"related":["prostate-roadmap","idea-prostate-metastatic-presentation-as-the-screening-endpoint"],"cancers":["prostate"],"sections":["early-detection"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-overdiagnosis","b-patient-voice"],"keyPapers":["paper-welch-j-natl-cancer-inst"],"journals":[],"dependsOn":[],"notes":[],"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.","test":"600-man RCT in five centres.","maturity":"speculative","actor":"research","cost":"small","horizonYears":2},"route":"/ideas/idea-prev-gleason6-terminology-rct/","neighbours":{"roadmap":[{"id":"prostate-roadmap","kind":"roadmap","name":"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","route":"/roadmaps/prostate-roadmap/"}],"idea":[{"id":"idea-prostate-metastatic-presentation-as-the-screening-endpoint","kind":"idea","name":"Judge a prostate screening programme on metastatic presentation, not on incidence or mortality","route":"/ideas/idea-prostate-metastatic-presentation-as-the-screening-endpoint/"}],"cancer":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"bottleneck":[{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"},{"id":"b-patient-voice","kind":"bottleneck","name":"Patients lack understanding, navigation and agency","route":"/bottlenecks/b-patient-voice/"}],"paper":[{"id":"paper-loeb-overdiagnosis-overtreatment-prostate-eur-urol-2014","kind":"paper","name":"Overdiagnosis and overtreatment of prostate cancer","route":"/key-papers/paper-loeb-overdiagnosis-overtreatment-prostate-eur-urol-2014/"},{"id":"paper-welch-j-natl-cancer-inst","kind":"paper","name":"Overdiagnosis in cancer","route":"/key-papers/paper-welch-j-natl-cancer-inst/"}]}}