More men with prostate cancer are avoiding unnecessary surgery

Prostate cancer is a leading cause of cancer-related death among men in the United States.

Despite this, widespread adoption of prostate cancer screening has been controversial.

Many primary care doctors worry that screening will lead to unnecessary surgery for men with low risk prostate cancer and current guidelines recommend screening only after discussing the risk of overtreatment with the patient.

In a study, published in JAMA Oncology, researchers at University of Michigan showed that the proportion of patients undergoing prostatectomy for the lowest-risk type of cancer dropped over fivefold between 2010 to 2024.

They concluded that efforts to increase active surveillance and improved diagnostic methods have helped more men avoid unnecessary surgery.

Nearly 300,000 men in the U.S. are expected to be diagnosed with prostate cancer in 2024 alone.

However, not all prostate cancers are the same. Some grow so slowly that they’re unlikely to ever cause problems, especially in older men.

“The discrepancy between how common prostate cancer is and the hesitance in adopting screening exists because, historically, prostate cancer has been considered overtreated,” said Steven Monda, M.D., urologic oncology researcher and first author of the study.

“Prostate cancer in many men does not require treatment. However, in the past, most of these men still underwent surgery or radiation after their diagnosis, which led to hesitance in the widespread adoption of screening.”

Guidelines on screening have also been inconsistent.

In 2012, the U.S. Preventative Task Force recommended against routine screening of prostate-specific antigen, or PSA, levels due to concerns about overtreatment. 

Prostate cancer in many men does not require treatment. However, in the past, most of these men still underwent surgery or radiation after their diagnosis, which led to hesitance in the widespread adoption of screening.” 

This stance was softened in 2018 to allow PSA screening only after patients discussed the risks and benefits with their doctor.

“Even though the 2012 USPTF guidelines were revised, many primary care doctors never went back to screening,” said Tudor Borza, assistant professor of urology and senior author on the study.

“As a result, even people at a higher risk, such as African American men or those with a family history of prostate cancer, aren't being offered screening.”

In the current study, the group analyzed data from over 180,000 men who had prostate cancer surgery between 2010 and 2024. 

They focused on patients with Grade Group 1 prostate cancer, which is the lowest-risk category.

These are the men most likely to be good candidates for active surveillance, an approach in which doctors monitor the cancer with regular tests and intervene only if it worsens.

Using two prostate cancer registries—one national and one based in Michigan—the researchers showed that the proportion of patients undergoing prostatectomy for the lowest risk type of cancer dropped over fivefold from 2010 to 2024.

In 2010, one in three men who had prostate cancer surgery nationally had the low risk type. By 2020, that number dropped to less than one in 10.

In Michigan, where urologists have been working for years on quality improvement through a program called MUSIC, the proportion dropped from about one in five in 2012 to less than one in 35 in 2024.

The study also found that, across different surgical practices throughout the state, rates of unnecessary surgery declined consistently. 

“The results who that this is a system-wide improvement,” Monda said.

“We’re seeing progress at the local practice, statewide and national levels.”

These results align with other studies that showed increased use of active surveillance for low risk prostate cancer since 2010.

“The decrease in the number of surgeries for low-grade prostate cancer shows that active surveillance helps,” Monda said.

“Routine PSA checks, MRIs and biopsies can ensure that prostate cancer doesn't progress to a condition that requires treatment.”

Additional authors: Timothy Demus, Salvador Jaime-Casas, Sabir Meah, Arnav Srivastava, Richard Sarle, Corinne Labardee, Khurshid R. Ghani, Kevin M. Ginsburg and Todd M. Morgan.

Funding/disclosures: Blue Cross Blue Shield of Michigan as part of the BCBSM Value Partnerships Program. Monda is supported by the National Institutes of Health/National Cancer Institute Advanced Training in Urologic Oncology Grant (T32 CA180984) and the Clark Family Fellowship in Kidney Cancer Research. Borza is supported by the Agency for Healthcare Research and Quality (K08HS028474).

Paper cited: “Trends in Surgical Overtreatment of Prostate Cancer,” JAMA Oncology. DOI: 10.1001/jamaoncol.2025.096

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