Decline in the Surgical Overtreatment of Prostate Cancer

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVE: Overtreatment of prostate cancer is a public health concern and a barrier to prostate cancer screening. The 2012 and 2018 US Preventative Task Force (USPTF) reports cite overtreatment of indolent disease, and its associated morbidity, as a major limitation to the safety of widespread screening. We sought to evaluate the rates of surgical overtreatment of prostate cancer over the last two decades. METHODS: We evaluated the proportion of prostatectomies with pathologic Grade Group (pGG1), as a surrogate for clinically insignificant disease, between 2010 and 2024 within the Michigan Urological Surgery Improvement Collaborative (MUSIC) and the Surveillance Epidemiology and End Results (SEER) registry. MUSIC served as a statewide sample with a focus on validated urology outcomes, while SEER served as a national sample. Within MUSIC, pGG1 was modeled in a mixed effects logistic model, against time while controlling for preoperative PSA, age, race, proportion and number of biopsy cores positive, and biopsy grade. We further assessed the proportion of these pGG1 prostatectomies with pre-operative higher-risk features: PSA≥10, >50% of biopsy cores positive, or clinical Grade Group 2 on biopsy. Presence of any of these risk features was modeled against time, controlling for age and race. RESULTS: Among 23,370 prostatectomies in MUSIC and162,558 prostatectomies in SEER, the proportion of pGG1 decreased over the time. The proportion of patients undergoing prostatectomy withpGG1 on final pathology decreased from 21% to 2.7% from 2012 to 2024 within MUSIC and from 32% to 7.8% from 2010 to 2020 within SEER. Within MUSIC, time was independently associated with a significant reduction in the proportion of prostatectomies that were pGG1 (OR 0.52 per 5-years, 95% CI 0.47-0.57).During these time periods, the proportion of patients undergoing pGG1 prostatectomies with pre-op PSA≥10 increased from 6.0% to 13% within MUSIC and increased from 8.1% to 10% within SEER. The proportion of pGG1prostatectomies with>50% cores positive on preoperative biopsy increased from 3.6% to 19% within MUSIC and from 11.8% to 15% within SEER. Time was independently associated with a significant increase in the proportion of pGG1 prostatectomies that had any pre-operative higher-risk features (OR 2.25 per 5 years, 95% CI 2.07-2.46). CONCLUSIONS: The rate of surgical overtreatment of low-risk prostate cancer has profoundly declined over the last two decades. A lower proportion of prostatectomies are pGG1 and the pGG1prostatectomies being performed are more likely to have pre-operative features that are higher-risk.

Volume

213

Issue

5S

First Page

e781

Last Page

e781

Comments

American Urological Association Annual Meeting, April 26-29, 2025, Las Vegas, NV

DOI

10.1097/01.JU.0001109988.34650.0d.01

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