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前列腺癌外科过度治疗的趋势

Steven M Monda¹, Timothy Demus², Salvador Jaime-Casas³

¹Department of Urology, University of Michigan, Ann Arbor.

|April 28, 2025

概括

前列腺癌的过度治疗已经减少,自2010年以来,较少的低等级 (病理等级组1) 前列腺切除术进行. 那些仍然进行的患者更有可能具有更高风险的特征,这表明患者选择有所改善.

科学领域:

泌尿器科泌尿器科泌尿器科泌尿器科
在瘤学瘤学.
公共卫生公共卫生

背景情况:

前列腺癌的过度治疗是一个重要的公共卫生问题,可能会破坏查工作.
评估前列腺切除术病理等级的趋势可以作为过度治疗的替代标记.

研究的目的:

评估20多年来1组 (pGG1) 病理等级前列腺切除比例的变化.
确定pGG1前列腺切除术的特征,特别是那些具有较高风险的术前特征的前列腺切除术.

主要方法:

追溯队列研究分析了2010-2024年前列腺切除病理报告.
使用了两个并行注册表:监测,流行病学和最终结果 (SEER) 和密歇根泌尿外科改善协作 (MUSIC).
检查了pGG1案例中pGG1比例的主要结果和高风险特征的次要结果.

主要成果:

pGG1前列腺切除术的比例显著下降,从SEER的32.4%降至7.8%,MUSIC的20.7%降至2.7%.
最近的前列腺切除年份与两组群体中pGG1的可能性较低有关 (OR <0.5每5年).
在pGG1前列腺切除术中,最近的手术与更高的术前高风险特征的可能性有关 (或每5年约1.6).

结论:

自2010年以来,pGG1前列腺切除术的频率明显下降.
现在,pGG1前列腺切除术的病例更有可能代表患有更高风险疾病的患者.
这些趋势表明,改善了诊断途径,更好地遵守积极监测,并减少了临床上无关紧要的前列腺癌的不必要手术.

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