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Area of Science:

  • Urology
  • Oncology
  • Public Health

Background:

  • Overtreatment of prostate cancer is a significant public health issue, potentially undermining screening efforts.
  • Assessing trends in pathologic grade on prostatectomy serves as a surrogate marker for overtreatment.

Purpose of the Study:

  • To evaluate changes in the proportion of prostatectomies with pathologic grade group 1 (pGG1) over two decades.
  • To identify characteristics of pGG1 prostatectomies, particularly those with higher-risk preoperative features.

Main Methods:

  • Retrospective cohort study analyzing prostatectomy pathology reports from 2010-2024.
  • Utilized two parallel registries: Surveillance, Epidemiology, and End Results (SEER) and Michigan Urological Surgery Improvement Collaborative (MUSIC).
  • Examined the primary outcome of pGG1 proportion and secondary outcome of higher-risk features in pGG1 cases.

Main Results:

  • The proportion of pGG1 prostatectomies significantly decreased from 32.4% to 7.8% in SEER and 20.7% to 2.7% in MUSIC.
  • More recent prostatectomy year was associated with a lower likelihood of pGG1 in both cohorts (OR < 0.5 per 5 years).
  • Among pGG1 prostatectomies, a more recent procedure was linked to a higher likelihood of preoperative high-risk features (OR ≈ 1.6 per 5 years).

Conclusions:

  • The frequency of pGG1 prostatectomies has markedly decreased since 2010.
  • Cases of pGG1 prostatectomy are now more likely to represent patients with higher-risk disease.
  • These trends suggest improved diagnostic pathways, better adherence to active surveillance, and reduced unnecessary surgeries for clinically insignificant prostate cancer.