title: Do low-grade and low-volume prostate cancers bear the hallmarks of malignancy?
abstract: Prostate cancer is generally multifocal and consists of a dominant focus-measured by tumour volume and deemed the index lesion-and one or more separate, secondary tumour foci of smaller volume. Much laboratory and clinical evidence has shown that we need to rethink how we regard low-grade and low-volume prostate lesions. In this Personal View, we discuss why small, low-grade Gleason pattern prostate lesions, which are currently designated as prostate cancer, could be regarded as non-malignant. These lesions either do not meet the criteria of the hallmarks of cancer or robust evidence that they do so is absent, by contrast with large lesions with a high Gleason grade, which seem to cause most metastatic disease.
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK. hashim.ahmed@ucl.ac.uk
authors.forename: Hashim Uddin
authors.initials: HU
authors.lastname: Ahmed
authors.forename: Manit
authors.initials: M
authors.lastname: Arya
authors.forename: Alex
authors.initials: A
authors.lastname: Freeman
authors.forename: Mark
authors.initials: M
authors.lastname: Emberton
mesh_terms: D017209:Apoptosis; D002450:Cell Communication; D006801:Humans; D061346:Laser Capture Microdissection; D008297:Male; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009389:Neovascularization, Pathologic; D011471:Prostatic Neoplasms / Q000145:classification / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D015398:Signal Transduction; D059016:Tumor Microenvironment