[Overtreatment of localized prostate cancer in older men-do we need a new definition of clinical significance?]

Overtreatment of localized prostate cancer in older patients remains a problem in healthcare. The reasons for this are manifold and range from overdiagnosis to problematic incentives in the healthcare system. However, another reason could also lie in the current nomenclature of the disease, which narrows clinical significance down to biological parameters of the disease and neglects key patient-specific dimensions such as life expectancy. A new definition, in which clinical significance is established solely through the patient context, is proposed for discussion here. According to this definition, localized prostate cancer would be clinically significant, respectively clinically relevant, if its malignancy-associated risk is highly likely to lead to morbidity or mortality within the patient's individual life expectancy without treatment. This approach would clearly counteract the structural imbalance whereby tumors whose malignant potential could not or would hardly manifest within a patient's remaining life expectancy are no longer considered significant. Accordingly, this could significantly sharpen the quality of indications for performing diagnostic and therapeutic procedures and thus have the potential to limit both overdiagnosis and overtreatment. This would be particularly important in the light of demographic trends.