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Prostate cancer (PCa) is the most prevalent cancer in males.1 Approximately 240,890 new cases are anticipated in 20111—making it the most frequently diagnosed of all new cancers (25%)2—and 33,720 men will die of it.1
More than $104 billion is spent annually in the United States on cancer care,3 or 5% of all spending for health care.4 Currently, there are approximately 2 million men with PCa.4 In 2006, the National Cancer Institute attributed $9.9 billion in total medical expenditures to PCa compared with $13.9 billion for breast cancer, $12.2 billion for colorectal cancer, $10.3 billion for lung cancer, and $10.2 billion for lymphoma.3 For PCa, $3.92 billion was spent on initial care (39.7%), $5.03 billion on continuing care (51%), and $918 million in the last year of life (9.3%).3 For those with metastatic disease, 50% of the total lifetime costs of treating PCa may occur in the last year of life.5
As the population ages, the significant clinical and economic societal burden of PCa is expected to increase.2 The discordance between incidence and mortality argues in favor of approaching PCa as a chronic disease. Therefore, since men generally live for many years following a diagnosis of PCa (median age at diagnosis is 67 years and median age at death, 80 years),6 the implications of long-term management and follow-up of these patients can be significant. Considerations include individualizing therapy with clearly defined goals that focus on specific treatments, adverse events, quality of life (QoL), and a patient’s financial situation.
This article reviews costs of care for PCa, from initial treatment to metastatic and castration-resistant disease, recognizing that few clinical trials have included economic assessments of managing the disease. Instead, trials have primarily focused on prolonging survival while maintaining or improving QoL.7 One should consider that management practices are in flux and subject to myriad clinical, scientific, demographic, and economic dynamics, with practices varying among academic, community, and individual settings.8