Although national guidelines recommend against prostate cancer screening in men aged 70 and older, researchers from the University of North Carolina Lineberger Comprehensive Cancer Center estimate that screening and treatment for men in this age group costs Medicare more than $1.2 billion over a three year period for each group of men diagnosed annually.
The study examined the costs associated with screening for prostate cancer, including treatment, for three years after diagnosis. Authors estimated that for men diagnosed in 2004, 2005, 2006 and 2007, the total cost for treating and screening for each group would be $1.2 billion for three years after diagnosis.
Findings also showed that of the total, $451 million was spent on men who were diagnosed with prostate cancer that is graded with a Gleason score of 6, which is considered to be a low-grade disease and best managed using active surveillance rather than aggressive treatment.
The main takeaway is that prostate cancer care is often not beneficial -- and often costly.
It is largely acknowledged that screening for prostate cancer should stop in men at age 70. The U.S. Preventive Services Task Force recommends against prostate cancer screening in men above age 70, claiming, among other reasons, that the harms from screening are "at least moderate" or greater for men in that age group because of risk of false-positives, harm from biopsy, and harm from treatment, which can include sexual dysfunction and urinary incontinence.
The median per-patient cost within three years after prostate cancer diagnosis was $14,453, with treatment costs accounting for 73 percent of that total. The researchers estimated a cost savings of $320 million per year for Medicare if patients who have a Gleason score of 6 choose active surveillance.
Foregoing aggressive treatment of low-risk prostate cancer in older patients, especially those with other health issues, could prevent harm due to treatment-related side effects, while also providing a savings to Medicare, the authors said.
They suggest that screening men with at least a 10-year life expectancy, and selectively treating those with more aggressive cancer, may be one approach to eliminate unnecessary spending while maximizing patient outcomes.