Impact of diagnostic labels and management benefit-to-harms information for low-risk prostate pathology.

Authors

Katy J L Bell, Farzaneh Boroumand, Zhuohan Wu, Timothy J Wilt, Lisa Parker, Jeremy Millar, Jenna Smith, Kirsten McCaffery, John Brandt Brodersen, Philipp Dahm, Brett Delahunt, Paul Glasziou, Andrew Warden, Lawrence Diller, Christo van Rensburg, Brooke Nickel

Published in

Journal of the National Cancer Institute. Jul 24, 2026. Epub Jul 24, 2026.

Abstract

To evaluate the effects of diagnostic labels and management benefit-to-harms information for low-risk prostate pathology.
Two factorial (3x2) online hypothetical experiments randomised participants 11:1 to three labels: "low-risk prostate cancer, Gleason Group 1", "low-risk prostate neoplasm", or "low-risk prostate lesion", with second randomisation 1:1 to high or low information on management options. Participants were Australians aged ≥50 years with a prostate (males) or with a male partner aged ≥50 years (females). The primary outcome was preference for management with curative-intent (prostatectomy; radiation therapy) or conservative management (PSA monitoring; active surveillance).
For 1340 males and 1435 females randomised April to June 2024, 50% vs 34% preferred PSA monitoring, 37% vs 46% active surveillance, 7% vs 11% prostatectomy, and 7% vs 8% radiotherapy. The "neoplasm" label reduced preference for curative-intent treatment in both males (low information Risk Difference (RD)-3.9%[95% CI:-10.5%,2.7%], high information RD: -5.2%[95% CI:-10.6%,0.2%]) and females (low information RD:-6.6% [95% CI:-14.3%,1.1%], high information RD: -2.3%[95%CI:-8.9%,4.3%]). The "lesion" label reduced preference for curative-intent treatment in females within low information groups (RD:-11.6%[95%CI:-18.9%,-4.3%]) but had minimal effect in males and in females within high information groups. High information reduced preference for curative-intent treatment within "cancer" label in both studies (males RD:-4.0%[95% CI:-10.5%,2.5%]; females RD:-10.3%[95%CI:-17.7%,-2.9%]). The combination of "neoplasm" and high information resulted in the largest effects (males RD:-9.2%[95%CI:-15.1%,-3.3%]; females RD:-12.6% [95% CI: -19.9%, -5.2%]).
Clear communication about management benefit-to-harms, and using "neoplasm" to describe low-risk prostate pathology may support conservative management choices and mitigate overtreatment.
ANZCTR 386701;386889.

PMID:
42496667
Bibliographic data and abstract were imported from PubMed on 24 Jul 2026.

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