Trends in Surgical Overtreatment of Prostate Cancer
Menée à partir de données 2010-2024 des registres américains des cancers portant sur 162 558 patients atteints d'un cancer de la prostate (âge médian : 63 ans) et de données du registre de l'Etat du Michigan portant sur 23 370 patients (âge médian : 64 ans), cette étude de cohorte rétrospective analyse l'évolution de l'utilisation de la prostatectomie radicale
Importance : Overtreatment of prostate cancer is a public health concern that undermines prostate cancer screening efforts.
Objective : To assess trends in pathologic grade on prostatectomy during the past 2 decades as a surrogate for overtreatment.
Design, Setting, and Participants : This retrospective cohort study examined the grade of prostate cancer on final pathology reports among patients undergoing prostatectomy between January 1, 2010, and September 1, 2024, in 2 parallel cohorts: Surveillance, Epidemiology, and End Results (SEER), a nationwide cancer registry, and Michigan Urological Surgery Improvement Collaborative (MUSIC), a statewide clinical registry. The presence of higher-risk features among patients who underwent grade group 1 prostatectomy during this period was also assessed.
Exposures : The primary exposure of interest was year of radical prostatectomy.
Main Outcomes and Measures : The primary outcome was the proportion of all prostatectomies that were pathologic grade group 1 (pGG1) on final pathology reports. The secondary outcome was the proportion of pGG1 prostatectomies with a higher-risk preoperative feature, assessed as a binary variable and including at least 1 of the following: more than 50% of biopsy cores positive, prostate-specific antigen of 10 ng/mL or higher, or grade group 2 on biopsy.
Results : A total of 162 558 male patients in SEER (median [IQR] age, 63 [57-67] years) and 23 370 in MUSIC (median [IQR] age, 64 [59-69] years) underwent prostatectomy. The proportion of radical prostatectomies resulting in pGG1 on final pathology reports decreased from 32.4% (5852 of 18 071) to 7.8% (978 of 12 500) between 2010 and 2020 in SEER and from 20.7% (83 of 401) to 2.7% (32 of 1192) between 2012 and 2024 in MUSIC. A more recent prostatectomy was associated with a lower likelihood of a pGG1 prostatectomy while controlling for age and race within SEER (odds ratio [OR] per 5 years, 0.41; 95% CI, 0.40-0.42; P < .001) and MUSIC (OR per 5 years, 0.39; 95% CI, 0.36-0.43; P < .001). Within a subset analysis of those prostatectomies that were final pGG1, a more recent prostatectomy was associated with the presence of a higher-risk preoperative feature, including more than 50% of biopsy cores positive, prostate-specific antigen of 10 ng/mL or higher, and grade group 2 on prior biopsy within SEER (OR per 5 years, 1.60; 95% CI, 1.54-1.67; P < .001) and MUSIC (OR per 5 years, 1.60; 95% CI, 1.34-1.90; P < .001)
Conclusions and Relevance : This cohort study found that since 2010, the frequency of pGG1 prostatectomies markedly decreased, and those few that were performed were more likely to have a higher-risk feature. This reduction in the proportion of prostatectomies that are pGG1 likely reflects improved diagnostic pathways, adherence to active surveillance protocols for low-risk cases, and ongoing efforts at both the state and national levels to minimize unnecessary surgical interventions in patients diagnosed with clinically insignificant prostate cancer.
JAMA Oncology , article en libre accès 2025