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Scott Eggener: The public health would be improved if Grade Group 1 was no longer called cancer. And we've tacitly been moving in that direction. There's a whole bunch of biomarkers that look not to diagnose Grade Group 1; that's the main attraction, it's one of the main attractions of MRI. There's a whole longstanding rich literature of clinically insignificant prostate cancer, and I can't think of a better way to honor that term than to take away the most significant portion of it, which is the term cancer. And there's a lot of us that believe that it should really just be a biomarker that places someone at higher risk of developing what we would call real cancer.

Histologically, we would all agree it meets the current criteria of cancer, but that's very different than clinically, where I would argue there's never been anyone who's had symptoms from it. It literally cannot metastasize unless it's very rarely in a sea of high-grade cancer, and I would argue, as I always have, that there's never been a man in human history who's died from contemporarily-graded pattern 3 prostate cancer.

So ontologically with a T, I think it's important to think about cancer as a social construct in addition to oncology and how we define what is cancer. And it's interesting to think that cancer was defined 4,500 years before we had a microscope, and now we're wedded to the microscope. And 99% of epithelial cancers, to my understanding, are defined because they all have a basement membrane. But we make exceptions when it makes sense. So intraductal cancer of the prostate, DCIS of the breast, basement membranes intact. And it makes sense, currently, to do that. I'm not sure why we can't make an exception the other way.

Speaker 2: DCIS isn't cancer, either.

Scott Eggener: Okay. I don't know why we can't make an exception for Grade Group 1 in the other direction. People often say this is an initiative to enhance active surveillance in the US, 40% of people are still getting treated immediately when they're diagnosed with low-risk disease, but I would argue that even if we had appropriately high surveillance rates with a name change, even though it would be called screening still, I would still argue that we should consider a name change.

There's a lot of different stakeholders involved, there's a lot of different perspectives, there's some big personalities, and I'm going to be self-evident to say we're going to treat everyone with respect and dignity. And I'm going to be banging a gong, honoring those three minutes we gave you and I did the same. I would just close, even though it sounds kind of trite and reductive, the main focus of today is to focus on individual health and population health, and I'm confident if we all focus on that, it's going to be stimulating, enjoyable, and hopefully productive. Thanks all for being here.