Two studies in last week’s New England Journal Of Medicine showed disappointing results from prostate cancer screening. This is a reminder that investments in preventive care are not always a good idea. The United States study, completed in 10 centers, included 77,000 patients and showed a nonsignificant increase in death rates among those patients who were randomly assigned to screening. The European study, an amalgam of seven different studies which had different designs, included 182,000 patients, and did show a decrease in death from prostate cancer of 7 per 10,000. However, 49 men were treated for prostate cancer for each life saved – leading to an enormous amount of incontinence and impotence.
I’ll turn 50 next year – and it’s not looking like I’ll be getting my first PSA test!
The morbidity from all prostate cancer treatment is considerable – whether prostate removal (radical prostatectomy) or radiation (either external beam or implantation of radiation ‘seeds’). There is has been little written about the cost of the increased cancer diagnosis from prostate cancer screening – so I figured I would provide some “back of the envelope” guesstimates of the cost of our prostate cancer screening.
Population: 18.7 million ages 50-59 (United States)
Increased Cancer Diagnoses: 3.4% (8.2% in the screening group and 4.8% in the control group)
è Increased Cancer diagnoses: 638,542 for this population over about a decade
Distribution of Treatment (and associated cost)
Wilson, et al Cumulative cost pattern comparison of prostate cancer treatments, Cancer 109: 18-527
Note that this is Medicare data, so this understates the cost compared to a population under 65.
è Total excess cost over 10 years for this population: $27 billion
That’s not a trivial figure even in these days of massive corporate bailouts.
| | %age | Cost | # | Spend |
| Radical Prostatectomy | 55% | $ 36,888 | 350,055 | $ 12,912,828,840 |
| Cryotherapy | 3% | $ 43,108 | 18,933 | $ 816,163,764 |
| Brachytherapy | 15% | $ 35,143 | 93,684 | $ 3,292,336,812 |
| External Beam | 9% | $ 59,455 | 57,360 | $ 3,410,338,800 |
| Androgen | 13% | $ 69,244 | 85,129 | $ 5,894,672,476 |
| Watchful Wait | 5% | $ 32,135 | 33,378 | $ 1,072,602,030 |
| TOTAL INCREASED SPENDING | | | | $ 27,398,942,722 |
