A new study from the University of Michigan shows a dramatic decline in unnecessary prostate surgeries for low-risk cancer patients, thanks to active surveillance and better diagnostic techniques.
Prostate cancer ranks as a major cause of cancer-related deaths among men in the United States. But a promising new study from the University of Michigan, published in JAMA Oncology, reveals a significant shift that could substantially impact patient care and outcomes.
The research shows that the rate of unnecessary prostatectomies for men diagnosed with the lowest-risk type of prostate cancer has dropped over fivefold between 2010 and 2024. This dramatic decline underscores the effectiveness of active surveillance and improved diagnostic methods in managing the disease.
Prostate cancer screening has been a contentious topic due to concerns over the potential for overtreatment.
Many primary care physicians worry that screening could lead to unneeded surgeries for men with low-risk prostate cancer, thus the guidelines emphasized caution, recommending screening only after health care providers thoroughly discussed the risks and benefits with patients.
“The discrepancy between how common prostate cancer is and the hesitance in adopting screening exists because, historically, prostate cancer has been considered overtreated,” first author Steven Monda, a urologic oncology researcher at the University of Michigan, said in a news release.
He explained that many men diagnosed with prostate cancer — particularly those with slow-growing types — did not require immediate surgery or radiation, leading to the initial hesitance to widely adopt screening practices.
This cautious approach was reflected in the 2012 guidelines by the U.S. Preventive Services Task Force, which recommended against routine prostate-specific antigen (PSA) screening to avoid the dangers of overtreatment.
Although these guidelines were relaxed in 2018 to permit PSA screening after patient-doctor discussions, lingering hesitancy remained among primary care professionals.
“Even though the 2012 USPTF guidelines were revised, many primary care doctors never went back to screening,” added senior author Tudor Borza, an assistant professor of urology at the University of Michigan. “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.”
The study analyzed data from more than 180,000 men who underwent prostate cancer surgery between 2010 and 2024, focusing on those with Grade Group 1 prostate cancer. This category represents the lowest-risk prostate cancers, making its patients ideal candidates for active surveillance — a strategy where doctors monitor cancer closely and only intervene if it progresses.
Employing data from both national and Michigan-based prostate cancer registries, the researchers discovered that the national proportion of patients with low-risk prostate cancer undergoing surgery dropped from one in three in 2010 to less than one in 10 by 2020.
In Michigan, where a quality improvement program named MUSIC has been active, the numbers fell from one in five in 2012 to less than one in 35 by 2024.
“The results show that this is a system-wide improvement,” Monda added. “We’re seeing progress at the local practice, statewide and national levels.”
The findings align well with other studies indicating an increased use of active surveillance for low-risk prostate cancer since 2010. This strategy involves routine PSA checks, MRIs and biopsies to ensure the cancer doesn’t advance to a stage requiring treatment.
“The decrease in the number of surgeries for low-grade prostate cancer shows that active surveillance helps,” added Monda. “Routine PSA checks, MRIs and biopsies can ensure that prostate cancer doesn’t progress to a condition that requires treatment.”