Surgical Overtreatment of Prostate Cancer May Be Decreasing
In a study of patients who underwent radical prostatectomy for prostate cancer (PCa), investigators found that almost all patients in recent years have had clinically significant tumours, according to a new report.
The finding suggests that overtreatment of PCa with surgery is in decline, which increases the benefits and decreases the risks of PCa screening, the investigators concluded.
The proportion of patients who had intermediate- or high-risk disease, based on National Comprehensive Cancer Network criteria, rose from 46.7% in 2009 to 90.2% in 2015. The proportion of men with clinically significant cancer at RP-which the authors defined as a Gleason score of 7 or greater or pathologic stage T3 or higher-increased by 5% per year during the study period.
Also during the study period, the proportion of tumours with a Gleason score of 7 or higher at RP increased from 55.9% to 92.7%, and the proportion of cancers with pathologic stage pT3 disease increased from 25.2% to 45.1%.
These results mean that the patients are better selected and only high-risk patients are operated with minimal overtreatment like happened in the past. This can be due to less aggressive screening programs and active surveillance.
Witherspoon L, Lau JL, Breau RH, et al. Reducing overtreatment of prostate cancer by radical prostatectomy in Eastern Ontario: a population-based cohort study. CMAJ Open (2018;6:E197-E201.