Growing Trend of Avoiding Unnecessary Surgery Among Men with Prostate Cancer

Prostate cancer remains a significant concern as one of the leading causes of cancer-related deaths among men in the United States. Despite its prevalence, the approach to screening and treatment has been a topic of ongoing debate. Many primary care physicians express caution over widespread screening, worried it might lead to overtreatment of low-risk cases. Current guidelines emphasize informed discussions with patients about the risks and benefits before proceeding with screening tests like the prostate-specific antigen (PSA) test.

A recent study published in JAMA Oncology highlights a promising shift over the past decade: the proportion of men undergoing prostatectomy for the lowest-risk type of prostate cancer has decreased significantly. Data from 2010 to 2024 reveal that the number of surgeries for low-grade prostate cancer has fallen more than fivefold. This change is attributed to increased use of active surveillance—monitoring the cancer closely rather than immediate surgical intervention—and advancements in diagnostic techniques that better distinguish aggressive from indolent cancers.

Nearly 300,000 men are expected to be diagnosed with prostate cancer in 2024 alone. However, not all diagnosed prostate cancers pose the same threat; some evolve very slowly, especially in older men, making aggressive treatment unnecessary.

Experts emphasize that historically, the overhype around prostate cancer has led to excessive treatments, often involving surgery or radiation, even when such measures were not required. The 2012 U.S. Preventive Task Force recommendations against routine PSA screening, due to fears of overtreatment, contributed to inconsistent screening practices nationwide. Although guidelines were relaxed in 2018 to allow shared decision-making before testing, many primary care providers continued to avoid screening, particularly at higher risk groups like African American men and those with a family history.

The research involved analyzing data from over 180,000 men who underwent prostate cancer surgery between 2010 and 2024. Focused on patients with Grade Group 1 prostate cancer—the category most suitable for active surveillance—the study found a dramatic decline in surgeries for this low-risk group, both nationally and within Michigan, where efforts to improve quality of care have been especially robust.

This trend indicates system-wide improvements, with more men avoiding unnecessary and potentially harmful procedures. It underscores the importance of active surveillance, regular testing, MRIs, and biopsies in managing low-risk prostate cancer, thereby reducing overtreatment while ensuring effective monitoring.

Overall, the shift reflects a more tailored, evidence-based approach to prostate cancer management, improving patient quality of life and optimizing healthcare resources.

Source: https://medicalxpress.com/news/2025-05-men-prostate-cancer-unnecessary-surgery.html