, 2025-05-01 13:29:00
TOPLINE:
From 2010 to 2024, the rate of surgeries declined more than fivefold in patients with pathologic grade group 1 (pGG1) prostate cancer, a cohort study found. The small proportion that were performed increasingly involved patients with higher-risk features.
METHODOLOGY:
- Overtreatment of prostate cancer, particularly in men with low-risk disease, can result in unnecessary harms. Clinical guidelines increasingly recommend active surveillance over immediate surgery for men with low-risk prostate cancer.
- To evaluate trends in the surgical overtreatment of prostate cancer, researchers conducted a retrospective cohort study that analyzed data of patients who underwent a prostatectomy between January 2010 and September 2024 from two parallel registries: Surveillance, Epidemiology, and End Results (SEER) and Michigan Urological Surgery Improvement Collaborative (MUSIC).
- Data of 162,558 men from SEER (median age, 63 years; 13.0% Black; 80.2% White) and 23,370 from MUSIC (median age, 64 years; 12.3% Black; 75.1% White) were collected.
- Researchers assessed the proportion of prostatectomies resulting in pGG1 on final pathology and the presence of high-risk preoperative features, including PSA ≥ 10 ng/mL, grade group 2 on biopsy, or > 50% positive biopsy cores.
TAKEAWAY:
- In SEER, the proportion of prostatectomies with pGG1 fell from 32.4% in 2010 to 7.8% in 2020. In MUSIC, pGG1 rates declined from 20.7% in 2012 to 2.7% in 2024.
- A more recent surgery year was strongly associated with a reduced likelihood of pGG1 pathology (SEER odds ratio [OR] per 5 years, 0.41; MUSIC OR, 0.39; both P < .001).
- In both SEER and MUSIC, age (ORs per 5 years, 0.81 and 0.77, respectively) and Black race (ORs, 0.86 and 0.70, respectively) were linked to a lower likelihood of undergoing a pGG1 prostatectomy.
- Among patients with final pGG1 pathology, the likelihood of having a higher-risk feature increased over time (OR per 5 years, 1.60 in both SEER and MUSIC; both P < .001).
IN PRACTICE:
“Our analyses show that the proportion of prostatectomies that are pGG1 has decreased more than fivefold since 2010, and the pGG1 prostatectomies that are now performed are more likely to have higher-risk preoperative features,” the authors wrote.
“Although further improvement in surgical overtreatment of prostate cancer is necessary, these results reflect a dramatic shift in how low-risk prostate cancer has been managed in the US during the past 2 decades,” they concluded.
SOURCE:
This study, led by Steven M. Monda, MD, MSCI, Department of Urology, University of Michigan, Ann Arbor, was published online in JAMA Oncology.
LIMITATIONS:
The retrospective nature of the study and potential coding inaccuracies inherent to registry data may have introduced bias. Additionally, these findings based on SEER and MUSIC data may not be generalizable to all regions and populations in the United States.
DISCLOSURES:
MUSIC received support from Blue Cross Blue Shield of Michigan as part of its Value Partnerships Program. Two authors received funding support through grants from the National Institutes of Health/National Cancer Institute Advanced Training in Urologic Oncology and Agency for Healthcare Research and Quality, of whom one also received the Clark Family Fellowship in Kidney Cancer Research. One author reported receiving personal fees from Foundation Medicine and Tempus AI, outside the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
