Most Low-Risk Prostate Cancer in the US Now Goes Untreated
US data show low-risk prostate cancer is diagnosed less often, and nearly all such patients in the VA system now avoid radiation and surgery.
Fewer men in the United States are being diagnosed with low-risk prostate cancer, and most of those who are diagnosed now avoid radiation and surgery. An analysis published in the journal CANCER describes a broad shift toward active surveillance.
The shift follows concerns about overdiagnosis and overtreatment. In the 2010s, recommendations for PSA-based screening wavered because of concerns about unnecessary treatment of slow-growing, localized cancers, and guidelines came to support active surveillance for low-risk disease.
Three data sets
To see whether practice followed the guidelines, the investigators examined localized prostate cancer cases in the SEER cancer registry program (2010-2023), the Veterans Affairs health system (2010-2024) and the Michigan Radiation Oncology Quality Consortium (2021-2025).
Low-risk cancer at diagnosis fell from 28.8% to 24.0% in SEER and from 32.3% to 21.9% in the VA. Among patients diagnosed with low-risk cancer, the share receiving neither radiation nor prostate removal rose from 33.6% to 83.4% in SEER by 2023, and from 51.6% to 96.3% in the VA by 2024.
The study also looked at 207,196 patients treated with radiation for localized disease. The share with low-risk cancer dropped from 33.7% to 6.5% in SEER and from 22.9% to 2.0% in the VA. In the more recent Michigan cohort it stayed low, between 2.8% and 4.2%.
"These data reflect broad changes in how prostate cancer is diagnosed and managed in the United States," said lead author Steven Monda of the University of Michigan. "We are seeing a moderate decline in the amount of low-risk prostate cancer being diagnosed, likely reflecting more magnetic resonance imaging use in screening," Monda said. "More so, however, we are seeing that most of the low-risk prostate cancer is now being appropriately observed and not treated. This is a big win for patients because it means patients are avoiding the harms of unnecessary treatment for cancers that are unlikely to ever affect them."
Source: Medical Xpress