Population‐level diagnostic and radiation treatment trends of low‐risk prostate cancer
Steven M. Monda, Varshini Odayar, Maggie Yin, Rachel Tucker Gonzalez, Salvador Jaime‐Casas, Karolyn M. Hopfensperger, Danielle Kendrick, Melissa A. Mietzel, Mazen Mislmani, Mark Zaki, Patrick W. McLaughlin, Todd M. Morgan, William C. Jackson, Matthew J. Schipper, David K. Heimburger, Alex K. Bryant, Lori J. Pierce, Tudor Borza, Robert T. DessAbstract
Background
Overtreatment of low‐risk prostate cancer (PC) undermines screening efforts. Active surveillance is preferred for low‐risk PC, but declining treatment may reflect diagnostic or treatment‐selection changes. We assessed diagnostic risk‐group trends among localized PC and low‐risk trends among radiation‐treated patients since 2010.
Methods
We analyzed localized PC in Surveillance, Epidemiology, and End Results Program (SEER; 2010–2023); Veterans Affairs (VA; 2010–2024); and Michigan Radiation Oncology Quality Consortium (MROQC; 2021–2025). Low‐risk PC was defined as grade group 1, prostate‐specific antigen <10 ng/mL, and clinical stage ≤T2a. Diagnosis‐based analyses described risk‐group trends among all localized PC diagnoses in SEER and VA and treatment among low‐risk patients. The primary outcome was the proportion of radiation‐treated patients classified as low‐risk, evaluated using logistic regression.
Results
Among localized PC, low‐risk disease at diagnosis declined from 28.8% to 24.0% in SEER and from 32.3% to 21.9% in VA. Among diagnosed low‐risk patients, receipt of neither radiation nor prostatectomy increased from 33.6% to 83.4% in SEER and from 51.6% to 96.3% in VA. Among 207,196 patients treated with radiation for localized PC (170,213 SEER; 34,635 VA; and 2348 MROQC), the proportion with low‐risk disease declined from 33.7% to 6.5% in SEER, from 22.9% to 2.0% in VA, and remained ≤4.2% in MROQC. Declines persisted after adjustment.
Conclusion
Since 2010, low‐risk PC has become less common at diagnosis, whereas diagnosed low‐risk patients increasingly avoid treatment. Radiation for low‐risk PC has markedly declined, paralleling surgical trends and reflecting a nationwide shift toward active surveillance.