Fewer US men diagnosed with low-risk prostate cancer as surveillance replaces treatment

A study published in Cancer reveals a major shift away from the overtreatment of low-risk prostate cancer in the U.S. Analyzing datasets from SEER, the VA, and MROQC, researchers found that low-risk diagnoses declined to 24.0% in SEER and 21.9% in the VA. Furthermore, active surveillance increased dramatically, with non-treatment rates for low-risk cases reaching 83.4% in SEER and 96.3% in the VA, spare patients unnecessary procedures.

Decline in low-risk prostate cancer diagnoses

• ▪Steven M. Monda of the University of Michigan stated that increased use of magnetic resonance imaging (MRI) in screening likely contributes to the moderate decline in low-risk prostate cancer diagnoses.
• ▪In the Veterans Affairs health system (VA) dataset from 2010 to 2024, low-risk prostate cancer at diagnosis declined from 32.3% to 21.9%.
• ▪In the Surveillance, Epidemiology, and End Results Program (SEER) dataset from 2010 to 2023, the proportion of low-risk prostate cancer at diagnosis declined from 28.8% to 24.0%.

Rise in active surveillance for low-risk cancer

• ▪Among low-risk prostate cancer patients in the Veterans Affairs health system, those receiving neither radiation nor prostate removal rose from 51.6% to 96.3% by 2024.
• ▪Among patients diagnosed with low-risk prostate cancer, those receiving neither radiation nor prostate removal increased from 33.6% to 83.4% in 2023 in the SEER registry.

Decline in Radiation treatment for low-risk cancer

• ▪Among 207,196 patients treated with radiation for localized prostate cancer, the proportion with low-risk disease dropped from 33.7% to 6.5% in SEER and 22.9% to 2.0% in the VA.
• ▪In the Michigan Radiation Oncology Quality Consortium (MROQC) cohort, low-risk disease accounted for 2.8% to 4.2% of patients receiving radiation for localized prostate cancer between 2021 and 2025.

Rationale for active surveillance over treatment

• ▪During the 2010s, medical guidelines shifted to support active surveillance for low-risk prostate cancer to prevent unnecessary treatment of slow-growing localized tumors that posed no threat to patients' lives.
• ▪Steven M. Monda noted that observing rather than treating low-risk prostate cancer allows patients to avoid the harms of unnecessary medical interventions for cancers unlikely to affect their health.

Study on prostate cancer trends

• ▪The study published in Cancer indicated a shift toward surveillance in response to concerns that overdiagnosis and overtreatment had hindered prostate cancer screening in the recent past.
• ▪A study published in Cancer by researchers including lead author Steven M. Monda of the University of Michigan evaluated diagnostic and radiation trends across the SEER, VA, and MROQC datasets.