LAUSR

Despite strong disagreements between them, both author teams share the belief that radical treatment for GS6 disease should be rare. We agree. But fully answering the question of whether to rename low-risk prostate cancer (including any GS6) is more than semantics. Words matter. What we say and how we say (name) it have important health and healthcare implications. In addition to the question of whether GS6 should be labelled a cancer, other steps should be taken to mitigate overdiagnosis and overtreatment harms while focusing treatments on those for whom it is effective and needed. We believe that, given the favourable natural history of GS6 disease in the PSA era, reducing intensity of AS protocols, including decreasing use of expensive and poorly validated biomarkers not demonstrated to have more than minimal incremental prognostic value, would decrease harms, complexity, and costs [7]. Recent data also suggest the same is true for favourable intermediate-risk (Grade Group 3) cancer. While MRI and biopsy-based AS represents advancement in the diagnosis and management paradigm, its effectiveness has never been established in randomized trials. Such trials should be conducted. Furthermore, watchful waiting deserves a larger role than current guidelines recommend, i.e. limiting use of watchful waiting only to men with very low-risk disease and life expectancy <5 years [8]. This is especially important given the effectiveness of newer medications in the small minority who develop advanced disease.