A LARGE retrospective cohort study has revealed a significant decline in the surgical overtreatment of low-risk prostate cancer over the past two decades. By analysing data from 185,928 male patients across two registries, Surveillance, Epidemiology, and End Results (SEER) and the Michigan Urological Surgery Improvement Collaborative (MUSIC), researchers found a more than fivefold reduction in the number of prostatectomies resulting in pathologic grade group 1 (pGG1) diagnoses from 2010 to 2024. This grade denotes the lowest-risk prostate cancer, often suitable for active surveillance rather than immediate surgery.
In SEER, the proportion of radical prostatectomies ending in pGG1 fell from 32.4% in 2010 to just 7.8% by 2020. Similarly, the MUSIC registry showed a decrease from 20.7% in 2012 to 2.7% in 2024. These figures suggest a clear shift away from unnecessary surgery for men with low-risk disease. Furthermore, among those still undergoing surgery for pGG1 cancer, there has been an increase in the proportion exhibiting higher-risk preoperative features—such as prostate-specific antigen levels of 10 ng/mL or above, grade group 2 on biopsy, or more than 50% of biopsy cores testing positive. This indicates that such cases are increasingly better selected for surgery based on more concerning preoperative findings.
The results highlight improved adherence to active surveillance protocols and reflect broader clinical and policy-level efforts to reduce overtreatment. This trend likely stems from growing awareness of the indolent nature of many prostate cancers and the desire to preserve quality of life without compromising outcomes. Overall, the findings underscore progress in the clinical management of prostate cancer, with evidence pointing to more appropriate use of surgery for those who truly need it, while sparing others the risks and consequences of unnecessary intervention.
Reference
Monda SM et al. Trends in surgical overtreatment of prostate cancer. JAMA Oncol. 2025;DOI:10.1001/jamaoncol.2025.0963.
