What is effect of Empagliflozin on Thyroid Hormones in prediabetics and diabetes patients?

This study from Kerman University of Medical Sciences have that empagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor used to treat type 2 diabetes, may significantly increase serum T3 levels and the T3/T4 hormone ratio in prediabetic and diabetic patients. However, it did not affect total T4 or thyroid-stimulating hormone (TSH) levels. The findings were published in the International Journal of Endocrinology.

Thyroid dysfunction (TD) and diabetes mellitus (DM) are the most widespread chronic endocrine disorders, frequently coexisting and often complicating each other’s management. Thyroid hormones play a pivotal role in glucose metabolism, and changes in their levels can influence diabetic outcomes. Despite this interplay, the effect of SGLT2 inhibitors like empagliflozin on thyroid function has remained largely unexamined, until now.

The quasi-experimental study from 2022 to  2023, involved 44 prediabetic and type 2 diabetic patients aged 18 to 65 who were not yet on blood sugar-lowering medication. The participants, all with HbA1c levels slightly above the therapeutic target, received 10 mg of empagliflozin daily for three months.

Blood tests were taken both before and after the treatment period to monitor fasting blood sugar (FBS), HbA1c, and key thyroid hormones (total T3, total T4, and TSH). A significant drop in FBS and HbA1c levels was observed after three months of empagliflozin use, indicating effective glycemic control.

A statistically significant increase in serum total T3 levels (p=0.001), which also led to an increased T3/T4 ratio that reflects thyroid hormone activity in peripheral tissues. No significant changes in T4 or TSH levels were observed, suggesting that the drug may specifically influence peripheral conversion of T4 to T3, rather than altering central thyroid function or overall hormone secretion.

The rise in T3 levels correlated with changes in weight and triglyceride levels, hinting at a broader metabolic effect of empagliflozin beyond glucose regulation. Overall, this research suggests that empagliflozin may play a role in modulating thyroid hormone activity, particularly by increasing the availability of active T3, which could have implications for managing patients with both diabetes and thyroid dysfunction. However, they caution that further large-scale studies are needed to confirm these findings and explore their clinical significance.

Source:

Sanjari, M., Sadeghi, N., Amirkhosravi, L., Hadavizadeh, M., Naghibzadeh-Tahami, A., & Safi, Z. (2025). Effect of empagliflozin on serum levels of thyroid hormones among prediabetic and diabetic patients. International Journal of Endocrinology, 2025(1), 9920286. https://doi.org/10.1155/ije/9920286

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Manipal Hospital Malleshwaram Boosts Cardiology Care with Advanced CATH Laboratory

Bengaluru: Addressing the increasing demand for specialized cardiac care, which is mostly seen in senior patients, Manipal Hospital Malleshwaram proudly reaffirms its commitment through its state-of-the-art technologies.   

Integral to the hospital’s renowned cardiology services, CATH Lab continues to play a pivotal role in meeting the increasing demand of patients and the significant rise in cardiology referrals and cases.   

The CATH Lab, equipped with cutting-edge technology, enhances Manipal’s team of distinguished interventional cardiologists to perform precise diagnostics and life-saving interventions. This facility has been strategically curated to respond and deliver to the evolving healthcare landscape, where the hospital has observed a marked increase in cardiac cases, especially among the elderly. By leveraging its advanced infrastructure, Manipal Hospital Malleshwaram ensures that patients receive timely, high-quality care tailored to their unique needs.

Also Read:India’s first robotic system performs 2 Cardiac Telesurgeries over 286 km

“Manipal Hospital Malleshwaram’s advanced CATH Lab reminds us how a healthy community is an integral part of our lives.” Dr Ashwath Narayan C N, MLA, Malleshwaram, Former DCM, Karnataka stated. “With the aim to build a community that has accessibility to the best facilities, we want to take every step required for the elderly in Bengaluru.”

The decision to focus on enhancing the CATH Lab’s capabilities stems from a thorough understanding of the community’s healthcare demands. Manipal’s ability to seamlessly integrate advanced technology with the skills of its cardiology specialists has positioned it as a leader in the field. This commitment is particularly significant for senior citizens, who often require specialized cardiac interventions to maintain their quality of life.  

Dr H Sudarshan Ballal, Chairman – Manipal Hospitals noted, “Our aim has always been to cater to every individual with proper diagnosis and timely interventions. Patient satisfaction with their requirements drives us to take more such initiatives.”

The Cardiology Department at Manipal Hospital continues to set benchmarks in patient care, combining innovation, expertise, and a patient-centric approach. The hospital’s efforts to strengthen its cardiac services strengthens its role as a trusted healthcare provider, ensuring that patients receive the highest standard of care. As Manipal Hospitals moves forward, its endeavours are always rooted to advancing healthcare solutions that meet the needs of the community it serves.

Also Read:Manipal Hospitals set new Guinness World Record of 3319 CPR performances within 24 hours

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Bedtime Dosing for Blood Pressure Drugs confers no added advantage: JAMA

Researchers have found in a Canadian randomized trial comparing morning and bedtime administration of blood pressure medications that there was no significant difference in cardiovascular outcomes. This held true both in primary care settings and in a related nursing home study. The results highlight that consistent medication adherence is more crucial than the timing of administration. This study published in JAMA was conducted by Scott R. and colleagues.

Hypertension is a potent risk factor for cardiovascular disease, including stroke, acute coronary syndrome, and heart failure. The literature has reported improved cardiovascular outcomes from nighttime control of blood pressure but with inconclusive evidence. In this study, the goal was to provide evidence regarding whether bedtime administration of antihypertensive agents reduces cardiovascular risk and safety outcomes.

This was a 3,357-person trial among hypertensive adults (56.4% female; median age, 67 years) that included recruitment via 436 Canadian province-based primary care clinicians. All participants were randomized in a 1:1 fashion to ingest all antihypertensive once-daily medications at bedtime (n = 1,677 in intervention group) or in the morning (n = 1,680 in control group).

Participants were older adults with hypertension who were on at least one once-daily antihypertensive drug. The major outcome was the time to initial event of all-cause mortality or hospital/emergency department (ED) visit for stroke, acute coronary syndrome, or heart failure. Secondary outcomes were unplanned all-cause hospitalizations/ED visits, and visual, cognitive, and fall- and/or fracture-related safety endpoints.

Key Findings

  • The rate of the primary outcome event was 2.3 per 100 patient-years in the bedtime group and 2.4 per 100 patient-years in the morning group (adjusted hazard ratio, 0.96; 95% CI, 0.77–1.19; P =.70).

  • There were no significant differences between the two groups for individual components of the primary outcome (stroke, acute coronary syndrome, heart failure).

  • Safety outcomes such as falls, fractures, glaucoma diagnosis, and 18-month cognitive impairment were not different between groups.

This large clinical trial showed that evening dosing of antihypertensive drugs did not decrease cardiovascular risk in comparison to morning dosing. Medication timing should be driven by patient preference rather than hopes for cardiovascular advantage.

Reference:

Garrison SR, Bakal JA, Kolber MR, et al. Antihypertensive Medication Timing and Cardiovascular Events and Death: The BedMed Randomized Clinical Trial. JAMA. Published online May 12, 2025. doi:10.1001/jama.2025.4390

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Adult-onset type 1 diabetes increases risk of CV disease and death, reveals research

A new study in the European Heart Journal shows that people who develop type 1 diabetes in adulthood have an increased risk of cardiovascular disease and death, and that those diagnosed later in life do not have a better prognosis than those diagnosed earlier. The study, conducted by researchers at Karolinska Institutet in Sweden, points to smoking, poor glucose control and obesity as the main risk factors.

Type 1 diabetes used to be called childhood diabetes but can start at any time during life. However, research on adult-onset type 1 diabetes is limited. The researchers behind the current study wanted to investigate the risk of cardiovascular disease and death in this group, particularly for those diagnosed after the age of 40.

The registry-based study identified 10 184 people diagnosed with type 1 diabetes in adulthood between 2001 and 2020 and compared them to 509 172 matched people in the control group.

The study shows that these people with adult-onset type 1 diabetes had a higher risk of cardiovascular disease and death from all causes, including cancer and infections, compared to the control group.

“The main reasons for the poor prognosis are smoking, overweight/obesity and poor glucose control. We found that they were less likely to use assistive devices, such as insulin pumps,” says first author Yuxia Wei, postdoctoral fellow at the Institute of Environmental Medicine, Karolinska Institutet.

The results emphasise the seriousness of type 1 diabetes, even when it starts later in life, the researchers say.

“But we show that the prognosis can be significantly improved by preventing smoking and obesity and improving glucose control, not least in people diagnosed at older ages,” explains senior author Sofia Carlsson, senior lecturer and associate professor at the same department.

The researchers plan to continue investigating adult-onset type 1 diabetes, including risk factors for developing the disease and the prognosis of other outcomes, such as microvascular complications. Optimal treatment in adult-onset type 1 diabetes, including the effect of pump use and other advanced technologies, also needs to be explored.

“We hope to shed light on these issues in the coming years,” concludes Sofia Carlsson.

Reference:

Yuxia Wei, Tomas Andersson, Tiinamaija Tuomi, Thomas Nyström, Sofia Carlsson, Adult-onset type 1 diabetes: predictors of major cardiovascular events and mortality, European Heart Journal, 2025;, ehaf304, https://doi.org/10.1093/eurheartj/ehaf304.

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High EASIX Scores Linked to Greater Mortality in ICU Patients with Atrial Fibrillation: Study Shows

China: A recent retrospective study using the MIMIC-IV database has highlighted the prognostic value of the Endothelial Activation and Stress Index (EASIX) in critically ill patients diagnosed with atrial fibrillation (AF). The findings, published in the European Journal of Medical Research, reveal that EASIX is closely linked with the likelihood of death during hospitalization, as well as within 28 days and one year of ICU admission.

Atrial fibrillation is a common cardiac arrhythmia seen in intensive care settings and is often associated with poor clinical outcomes. The EASIX score, originally developed to reflect endothelial dysfunction and stress, was evaluated in this study to determine its potential as a mortality predictor in AF patients requiring intensive care.

Yu Xia, Department of Burn and Trauma Medicine, First Naval Hospital of Southern Theater Command, Zhanjiang, China, and colleagues analyzed data from 4,896 adult patients with AF sourced from the MIMIC-IV critical care database. The EASIX score was calculated based on three routine laboratory markers: lactate dehydrogenase (LDH), creatinine, and platelet count. To strengthen the statistical rigor, advanced methods like the Boruta algorithm and LASSO regression were employed to identify key variables, while Cox regression and logistic models assessed the predictive value of EASIX.

The key findings of the study were as follows:

  • Higher EASIX scores were significantly linked to increased all-cause mortality during hospitalization at 28 days and one year.
  • Patients in the higher EASIX quartiles had markedly lower survival rates than those in the lowest quartile.
  • Kaplan-Meier survival analysis visually confirmed the inverse relationship between EASIX scores and survival outcomes.
  • The prognostic performance of EASIX was comparable to the SOFA score.
  • EASIX outperformed the CHA₂DS₂–VASc score in predicting mortality risk in critically ill patients with atrial fibrillation.
  • EASIX may be a practical and focused prognostic tool for clinicians managing critically ill AF patients.

What sets EASIX apart is its ability to capture the burden of endothelial dysfunction, which plays a critical role in the pathophysiology of AF and multi-organ failure. The strength of its association with mortality remained consistent even when accounting for various comorbidities and clinical interventions, highlighting its robustness as a risk stratification tool.

The study’s authors advocate for prospective studies to validate EASIX’s broader use in other patient groups and settings. Nevertheless, their findings support the integration of EASIX into clinical assessments of critically ill AF patients, offering a simple yet powerful method for the early identification of individuals at heightened risk of poor outcomes.

“EASIX emerges as a dependable indicator for predicting both short- and long-term mortality in critically ill patients with atrial fibrillation. However, further prospective studies are warranted to validate its utility across broader patient populations,” the authors wrote.

Reference:

Xia, Y., Liang, A., Wang, M. et al. Risk analysis of the association between EASIX and all-cause mortality in critical ill patients with atrial fibrillation: a retrospective study from MIMIC-IV database. Eur J Med Res 30, 344 (2025). https://doi.org/10.1186/s40001-025-02621-4

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Nut And Seed Intake Does Not Increase Diverticulitis Risk, unravels study

According to a new study published in Annals of Internal Medicine women who eat nuts, seeds, or corn are not at a higher risk of developing diverticulitis, unlike the popular belief that these foods might lead to the condition. This was concluded through the analysis of data from 29,916 women aged between 35 and 74 years, who were registered in a prospective cohort study. The trial, with almost 14 years of follow-up, offers strong evidence against dietary exclusion of these foods for the prevention of diverticulitis. The study was conducted by Barlowe T. and colleagues.

Diverticulitis is a frequent gastrointestinal illness in which small, bulging pouches (diverticula) within the digestive system become infected or inflamed. In the past, patients with diverticulosis were cautioned to exclude from their diets such foods as nuts, seeds, and corn because they were considered to get stuck in the diverticula and cause inflammation. But earlier work in men had already contradicted this belief. This new research carries the evidence over to women, finding that consumption of nuts, seeds, and corn does not raise the risk of diverticulitis.

The analysis involved 29,916 women aged 35-74 years who were cancer-free, diverticulitis-free, and free of inflammatory bowel disease at baseline. The assessment of dietary intake was done using food frequency questionnaires, while the occurrence of diverticulitis was established using self-reports. Investigators used Cox proportional hazards models after controlling for demographic and health characteristics to determine the association between dietary elements and the risk of diverticulitis.

Key Findings

  • Upon a mean follow-up of 13.9 years, 1,531 cases of incident diverticulitis were ascertained.

  • Consumption of peanuts, nuts, and seeds was not linked with diverticulitis risk (adjusted hazard ratio [aHR] for highest vs. lowest quartile, 1.07).

  • Corn consumption was inversely related to diverticulitis risk, with individuals in the highest quartile showing decreased risk (aHR, 0.86).

  • Women in the top quartile of DASH diet adherence had a 23% lower risk of diverticulitis (aHR, 0.77).

  • Comparable risk reductions were observed with the Healthy Eating Index (aHR, 0.78) and the Alternative Healthy Eating Index (aHR, 0.81).

This research presents strong evidence that intake of nuts, seeds, or corn does not raise the risk of diverticulitis in women. Furthermore, compliance with healthy eating patterns, including the DASH diet, was linked to a lower risk of diverticulitis. These results contradict the traditional advice to exclude nuts and seeds from the diet for the prevention of diverticulitis and recommend the consumption of these foods as part of a healthy diet without fear.

Reference:

Barlowe, T., Anderson, C., Nichols, H. B., Salvador, A. C., Sandler, R. S., Sandler, D. P., & Peery, A. F. (2025). Diet and risk for incident diverticulitis in women : A prospective cohort study. Annals of Internal Medicine. https://doi.org/10.7326/ANNALS-24-03353

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Inflammation and Remnant Cholesterol Together Drive Highest Heart Risk in Kidney Patients: Study Shows

Denmark: Emerging evidence published in the Atherosclerosis journal points to a concerning association between low-grade inflammation, elevated remnant cholesterol levels, and an increased risk of cardiovascular events and mortality in individuals with compromised kidney function.  

The study, based on data from over 100,000 participants in the Copenhagen General Population Study, examined the long-term health outcomes of 9,935 individuals with impaired renal function, defined by an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m².

Daniel Elías-López, Department of Clinical Biochemistry, Copenhagen University Hospital – Herlev Gentofte, Borgmester Ib Juuls Vej 1, Herlev, DK-2730 Denmark, and colleagues aimed to determine whether low-grade inflammation, measured via high-sensitivity C-reactive protein (CRP), and elevated remnant cholesterol, not typically detected in routine LDL cholesterol testing, independently or jointly contributed to adverse health events in this population.

The following were the key findings of the study:

  • During follow-up, individuals with impaired kidney function experienced 566 myocardial infarctions (MIs), 1,122 atherosclerotic cardiovascular disease (ASCVD) events, and 3,139 deaths.
  • Participants with both elevated C-reactive protein (CRP) and high remnant cholesterol had a significantly higher risk of adverse outcomes compared to those with low levels of both markers.
  • The adjusted hazard ratio for myocardial infarction in individuals with both high CRP and high remnant cholesterol was 1.39.
  • The hazard ratio for ASCVD in this group was 1.33.
  • The hazard ratio for all-cause mortality in individuals with both elevated markers was 1.20.
  • Participants with high CRP but normal remnant cholesterol had a hazard ratio of 1.28 for myocardial infarction.
  • The hazard ratio for all-cause mortality in individuals with high CRP but normal remnant cholesterol was 1.18.
  • Participants with high remnant cholesterol but normal CRP had slightly elevated risks, though not all reached statistical significance.

Notably, these findings emphasize a potentially overlooked cardiovascular risk in patients with chronic kidney disease (CKD), as remnant cholesterol and inflammation are not typically the primary focus in conventional lipid assessments. While LDL cholesterol has long been the standard for evaluating cardiovascular risk, the current study sheds light on the importance of monitoring these alternative markers, especially in high-risk populations such as those with CKD.

The authors suggest that the dual presence of systemic inflammation and elevated remnant cholesterol acts synergistically to worsen vascular health, potentially accelerating atherosclerosis and contributing to adverse cardiovascular and mortality outcomes. These insights could inform future strategies for cardiovascular risk reduction in CKD patients.

Given the study’s observational nature, the researchers acknowledge the need for randomized controlled trials to explore effective interventions targeting remnant cholesterol and systemic inflammation. They propose that future research, potentially through target trial emulation, should aim to identify optimal therapeutic approaches for mitigating cardiovascular risks in individuals with impaired renal function.

“The large-scale analysis reveals that low-grade inflammation and remnant cholesterol, often missed in standard testing, may significantly amplify the risk of myocardial infarction, atherosclerotic events, and premature death in those with kidney impairment. These findings may play a pivotal role in guiding preventive strategies in this vulnerable population,” the researchers concluded.

Reference:

Elías-López, D., Kobylecki, C. J., Vedel-Krogh, S., Doi, T., & Nordestgaard, B. G. (2025). Association of low-grade inflammation and elevated remnant cholesterol with risk of ASCVD and mortality in impaired renal function. Atherosclerosis, 119241. https://doi.org/10.1016/j.atherosclerosis.2025.119241

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New radiotherapy technique may protect heart during lung cancer treatment: Study

A new study presented at ESTRO 2025 introduces the RAPID-RT study, which uses an innovative rapid-learning approach to evaluate the impact of treatment modifications in radiotherapy. Traditional clinical trials are often lengthy and are not representative of real-world patient populations due to complex consent processes and strict eligibility criteria. In contrast, RAPID-RT offers a more inclusive, real-world alternative. Researchers at The Christie NHS Foundation Trust in Manchester, UK, have applied this method in lung cancer patients to assess whether reducing the dose to the top of the heart-a hypothesised risk area, can improve survival by minimising cardiac toxicity associated with conventional radiotherapy.

Targeting Tumours, Protecting the Heart

Radiotherapy is a highly effective treatment for lung cancer, yet the heart is often located close to the tumour site. It is important that the dose to the heart is minimised to reduce the risk of serious complications. Previous research in Manchester using radiotherapy planning images identified the top of the heart as a particularly radiosensitive area in lung cancer patients, with radiation dose to this region found to be associated with overall survival.

Based on these results, a new “heart-sparing” technique was implemented in the routine clinical setting to address this challenge.

“RAPID-RT represents a shift towards more inclusive research, designed to reflect the realities of everyday clinical practice and ensure that all patients, not just those who meet narrow trial criteria, benefit from innovation in radiotherapy” said co-lead investigator Dr Gareth Price, senior lecturer and medical physicist, at the University of Manchester.

“We also hope that by reducing cardiac exposure, we may improve both survival and quality of life for patients.”

Key Data from Over 1,700 Patients

The RAPID-RT study analysed data from 1,708 patients with stage I–III lung cancer who received curative-intent radiotherapy between January 2021 and February 2025:

• Standard curative-intent radiotherapy treatment was given to 922 patients treated before April 2023.

• The new heart-sparing technique was applied prospectively to 786 patients from April 2023 onwards, using two key innovations:

• An inclusive rapid-learning study design: this approach enables fast recruitment by including all patients treated at the institution, unless they actively opt out of data collection.

• Limiting radiation to a defined Cardiac Avoidance Area (CAA): Radiation dose to sensitive parts of the heart was limited to at 19.5 Gy (or equivalent) over 20-33 sessions, unless this restriction compromised adequate tumour coverage

• Early results show that the rapid-learning method is highly inclusive as to date all patients with stage 1-3 NSCLC treated with conventional curative-intent radiotherapy received the new technique, with only 1 out of 786 patients choosing to opt out of the study. Initial findings suggest a modest improvement in 12-month survival following implementation of a dose limit to the top of the heart.

Faster Answers with Real-World Evidence

Unlike traditional clinical trials, which can take years to deliver results, the RAPID-RT study used a “rapid-learning” model, to evaluate and adapt treatments in real time using routine anonymised data from the electronic care record. This approach allows researchers to refine treatment strategies more quickly, bringing effective innovations to patients faster.

“This research is a perfect example of how innovation in radiotherapy is not only about technology, but also about how we learn, adapt, and deliver better care,” said Professor Matthias Guckenberger, President of ESTRO and Chair of Radiation Oncology at the University Hospital Zurich.

“It demonstrates the power of combining cutting-edge technology with real-world data to make radiotherapy safer and even more effective.”

Towards Smarter, More Inclusive Evaluation of Radiotherapy Modifications

RAPID-RT represents an important step towards more inclusive and pragmatic clinical trials in radiotherapy. The study provides compelling evidence that novel trial methods can effectively evaluate treatment modifications, especially in situations where traditional randomised trials are not feasible.

The study will continue to recruit and follow patients’ progress to confirm these early results and allow clinical teams to decide if patients might benefit from further refinement of the new radiotherapy technique. Ongoing analyses will assess the potential impact on long-term survival, radiotherapy-related toxicities, and explore alternative modelling approaches to better understand treatment outcomes.

Reference:

New radiotherapy technique aims to protect the heart during lung cancer treatment, European Society for Radiotherapy and Oncology (ESTRO), Meeting: ESTRO 2025.

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Electrolyte Levels May Predict Outcomes in Ischemic Stroke, reveals research

According to a study published in the Journal of the American Heart Association, serum potassium, calcium, and magnesium levels show potential as prognostic biomarkers for ischemic stroke outcomes. This study was conducted by Quan Yu and colleagues.

Ischemic stroke is the most common cause of death and disability globally, and the determination of prognostic factors is important for enhancing patient outcomes. Although elevated serum potassium, calcium, and magnesium have been linked with lower risk of ischemic stroke, their role in stroke prognosis is unknown. To inform this, a study was undertaken based on the Minhang Stroke Cohort data, examining the relationship between the serum electrolytes and stroke outcomes.

The analysis involved data from 5,469 patients with ischemic stroke in the Minhang Stroke Cohort. Baseline serum levels of potassium, calcium, and magnesium were measured. The main outcome was a composite of mortality and severe disability (modified Rankin Scale score ≥3) at 3 months after stroke. Secondary outcomes were mortality, severe disability, and the ordered 7-level modified Rankin Scale score. Associations were measured using multivariate models adjusted for potential confounders.

Results

At the 3-month follow-up, 1,834 patients had the primary outcome. With adjustment for confounders, patients in the highest quartile of serum electrolytes had significantly reduced risks of adverse outcomes relative to those in the lowest quartile:

  • Potassium: aOR 0.79 (95% CI, 0.68–0.93; P=0.007).

  • Calcium: aOR 0.69 (95% CI, 0.58–0.82; P<0.001).

  • Magnesium: aOR 0.83 (95% CI, 0.70–0.99; P=0.015).

Multivariable-adjusted restricted cubic spline analysis demonstrated linear dose-response relations between each of the electrolytes and favorable outcomes.

The results suggest that it is beneficial to maintain high-normal serum levels of potassium, calcium, and magnesium to have a favorable effect on outcome after ischemic stroke. These electrolytes are potential valuable prognostic biomarkers to influence clinical practice and interventions toward favorable patient prognosis.

High-normal serum levels of potassium, calcium, and magnesium were associated with decreased risks of unfavorable outcomes at 3 months after stroke. These results indicate the potential utility of these electrolytes as prognostic biomarkers for the management of ischemic stroke, highlighting the value of monitoring and ensuring optimal levels of these electrolytes in patients with stroke.

Reference:

Quan Yu, MD*; Yang Liu, MDhttps://orcid.org/0000-0001-5939-572X*; Xinyue Chang, MD*; Xueyu Mao, MDhttps://orcid.org/0000-0001-6143-197X; Xuechun Wu, MD; Min Chu, MD; Huicong Niu, MD, PhDhttps://orcid.org/0000-0001-9112-8883; Mengyao Shi, MD, PhD; Lulu Sun, MD; Yu He, MD; Yi Liu, MD; Daoxia Guo, MD, PhD; Zhengbao Zhu, MD, PhDhttps://orcid.org/0000-0001-5500-0014; Jing Zhao, MD, PhDhttps://orcid.org/0000-0001-5197-9181. High‐Normal Serum Potassium, Calcium, and Magnesium Levels Are Associated With Decreased Risks of Adverse Outcomes After Ischemic Stroke, Journal of the American Heart Association, 2025.

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More men with prostate cancer are avoiding unnecessary surgery, reveals JAMA study

Prostate cancer is a leading cause of cancer-related death among men in the United States.

Despite this, widespread adoption of prostate cancer screening has been controversial.

Many primary care doctors worry that screening will lead to unnecessary surgery for men with low risk prostate cancer and current guidelines recommend screening only after discussing the risk of overtreatment with the patient.

In a study, published in JAMA Oncology, researchers at University of Michigan showed that the proportion of patients undergoing prostatectomy for the lowest-risk type of cancer dropped over fivefold between 2010 to 2024.

They concluded that efforts to increase active surveillance and improved diagnostic methods have helped more men avoid unnecessary surgery.

Nearly 300,000 men in the U.S. are expected to be diagnosed with prostate cancer in 2024 alone.

However, not all prostate cancers are the same. Some grow so slowly that they’re unlikely to ever cause problems, especially in older men.

“The discrepancy between how common prostate cancer is and the hesitance in adopting screening exists because, historically, prostate cancer has been considered overtreated,” said Steven Monda, M.D., urologic oncology researcher and first author of the study.

“Prostate cancer in many men does not require treatment. However, in the past, most of these men still underwent surgery or radiation after their diagnosis, which led to hesitance in the widespread adoption of screening.”

Guidelines on screening have also been inconsistent.

In 2012, the U.S. Preventative Task Force recommended against routine screening of prostate-specific antigen, or PSA, levels due to concerns about overtreatment.

Prostate cancer in many men does not require treatment. However, in the past, most of these men still underwent surgery or radiation after their diagnosis, which led to hesitance in the widespread adoption of screening.”

This stance was softened in 2018 to allow PSA screening only after patients discussed the risks and benefits with their doctor.

“Even though the 2012 USPTF guidelines were revised, many primary care doctors never went back to screening,” said Tudor Borza, assistant professor of urology and senior author on the study.

“As a result, even people at a higher risk, such as African American men or those with a family history of prostate cancer, aren’t being offered screening.”

In the current study, the group analyzed data from over 180,000 men who had prostate cancer surgery between 2010 and 2024.

They focused on patients with Grade Group 1 prostate cancer, which is the lowest-risk category.

These are the men most likely to be good candidates for active surveillance, an approach in which doctors monitor the cancer with regular tests and intervene only if it worsens.

Using two prostate cancer registries—one national and one based in Michigan-the researchers showed that the proportion of patients undergoing prostatectomy for the lowest risk type of cancer dropped over fivefold from 2010 to 2024.

In 2010, one in three men who had prostate cancer surgery nationally had the low risk type. By 2020, that number dropped to less than one in 10.

In Michigan, where urologists have been working for years on quality improvement through a program called MUSIC, the proportion dropped from about one in five in 2012 to less than one in 35 in 2024.

The study also found that, across different surgical practices throughout the state, rates of unnecessary surgery declined consistently.

“The results who that this is a system-wide improvement,” Monda said.

“We’re seeing progress at the local practice, statewide and national levels.”

These results align with other studies that showed increased use of active surveillance for low risk prostate cancer since 2010.

“The decrease in the number of surgeries for low-grade prostate cancer shows that active surveillance helps,” Monda said.

“Routine PSA checks, MRIs and biopsies can ensure that prostate cancer doesn’t progress to a condition that requires treatment.”

Reference:

Monda SM, Demus T, Jaime-Casas S, Meah S, Srivastava A, Sarle R, Labardee C, Ghani KR, Ginsburg KM, Morgan TM, Borza T. Trends in Surgical Overtreatment of Prostate Cancer. JAMA Oncol. 2025 Apr 28:e250963. doi: 10.1001/jamaoncol.2025.0963. 

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