{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:47:01Z","timestamp":1793040421730,"version":"4.5.0"},"reference-count":19,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:sec id=\"ab-coi250014-4\"><jats:title>Importance<\/jats:title><jats:p>Overtreatment of prostate cancer is a public health concern that undermines prostate cancer screening efforts.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi250014-5\"><jats:title>Objective<\/jats:title><jats:p>To assess trends in pathologic grade on prostatectomy during the past 2 decades as a surrogate for overtreatment.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi250014-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This retrospective cohort study examined the grade of prostate cancer on final pathology reports among patients undergoing prostatectomy between January 1, 2010, and September 1, 2024, in 2 parallel cohorts: Surveillance, Epidemiology, and End Results (SEER), a nationwide cancer registry, and Michigan Urological Surgery Improvement Collaborative (MUSIC), a statewide clinical registry. The presence of higher-risk features among patients who underwent grade group 1 prostatectomy during this period was also assessed.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi250014-7\"><jats:title>Exposures<\/jats:title><jats:p>The primary exposure of interest was year of radical prostatectomy.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi250014-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was the proportion of all prostatectomies that were pathologic grade group 1 (pGG1) on final pathology reports. The secondary outcome was the proportion of pGG1 prostatectomies with a higher-risk preoperative feature, assessed as a binary variable and including at least 1 of the following: more than 50% of biopsy cores positive, prostate-specific antigen of 10 ng\/mL or higher, or grade group 2 on biopsy.<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi250014-9\"><jats:title>Results<\/jats:title><jats:p>A total of 162\u202f558 male patients in SEER (median [IQR] age, 63 [57-67] years) and 23\u202f370 in MUSIC (median [IQR] age, 64 [59-69] years) underwent prostatectomy. The proportion of radical prostatectomies resulting in pGG1 on final pathology reports decreased from 32.4% (5852 of 18 071) to 7.8% (978 of 12 500) between 2010 and 2020 in SEER and from 20.7% (83 of 401) to 2.7% (32 of 1192) between 2012 and 2024 in MUSIC. A more recent prostatectomy was associated with a lower likelihood of a pGG1 prostatectomy while controlling for age and race within SEER (odds ratio [OR] per 5 years, 0.41; 95% CI, 0.40-0.42; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) and MUSIC (OR per 5 years, 0.39; 95% CI, 0.36-0.43; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). Within a subset analysis of those prostatectomies that were final pGG1, a more recent prostatectomy was associated with the presence of a higher-risk preoperative feature, including more than 50% of biopsy cores positive, prostate-specific antigen of 10 ng\/mL or higher, and grade group 2 on prior biopsy within SEER (OR per 5 years, 1.60; 95% CI, 1.54-1.67; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) and MUSIC (OR per 5 years, 1.60; 95% CI, 1.34-1.90; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001)<\/jats:p><\/jats:sec><jats:sec id=\"ab-coi250014-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This cohort study found that since 2010, the frequency of pGG1 prostatectomies markedly decreased, and those few that were performed were more likely to have a higher-risk feature. This reduction in the proportion of prostatectomies that are pGG1 likely reflects improved diagnostic pathways, adherence to active surveillance protocols for low-risk cases, and ongoing efforts at both the state and national levels to minimize unnecessary surgical interventions in patients diagnosed with clinically insignificant prostate cancer.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoncol.2025.0963","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T06:30:22Z","timestamp":1745821822000},"page":"700","source":"Crossref","is-referenced-by-count":10,"title":["Trends in Surgical Overtreatment of Prostate Cancer"],"prefix":"10.1001","volume":"11","author":[{"given":"Steven M.","family":"Monda","sequence":"first","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Demus","sequence":"additional","affiliation":[{"name":"Department of Urology, Sparrow Health System, Lansing, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvador","family":"Jaime-Casas","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabir","family":"Meah","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnav","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Sarle","sequence":"additional","affiliation":[{"name":"Department of Urology, Sparrow Health System, Lansing, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinne","family":"Labardee","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khurshid R.","family":"Ghani","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin M.","family":"Ginsburg","sequence":"additional","affiliation":[{"name":"Department of Urology, Wayne State University, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd M.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tudor","family":"Borza","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann 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