With general consensus that those 70 years and older should not be routinely screened for prostate cancer, researchers argue that their study results identify an area for cutting low-value services to reduce healthcare spending.
Despite the US Preventive Services Task Force’s (USPSTF’s) recommendation against prostate screening for men 70 years and older, screening for and treating the disease in the patient population costs Medicare approximately $1.2 billion over a 3-year period.
In May, USPSTF released its final recommendation recommending that men aged 55 to 69 years make their own decision on whether to be screened for prostate cancer after they have had a conversation with their physician on potential benefits and harms. However, they said that for men 70 years and older, the potential benefits do not outweigh the harms, and they should not be routinely screened. This recommendation was in accordance with its 2012 statement.
With general consensus that those 70 years and older should not be routinely screened for prostate cancer, the researchers of a new study argue that their study results identify an area for cutting low-value services to reduce healthcare spending.
“For patients who are diagnosed with prostate cancer at an older age, because the cancer is often slow growing, it is unlikely to be the cause of their mortality,” said Ronald C. Chen, MD, MPH, associate professor, department of radiology, University of North Carolina School of Medicine, and the study’s corresponding author, in a statement.
He added, “So, we are not only spending US healthcare dollars diagnosing an issue that probably isn’t going to be a problem for patients, but when we treat these patients who don’t need treatment, they suffer unnecessary side effects.”
To determine the costs associated with screening for prostate cancer for 3 years after diagnosis, the researchers used the National Cancer Institute’s Surveillance, Epidemiology, and End Results program to collect data on 49,692 men 70 years and older diagnosed with localized prostate cancer between 2004 and 2007. Half of participants were aged 70 to 75 years and half were older than 75 years.
The median cost per patient within 3 years following prostate cancer diagnosis was $14,452, with treatment costs accounting for the majority ($10,558). For men older than 75 years, costs were lower than those for men aged 70 to 75 years.
Reflecting on the results, the authors wrote that diagnosing prostate cancer in this patient population may result in harm to patients and represent a misallocation of limited healthcare resources. They added that reducing aggressive treatment of low-risk prostate cancer in elderly patients represents an opportunity to benefit both the patient and healthcare spending.
“While the debate regarding prostate cancer screening has focused largely on the overdetection and overtreatment of low-risk cancers, it is also well established that high-risk cancers are life-threatening, and treatment can improve survival,” they wrote. “Thus, screening men with at least a 10-year estimated life expectancy and selectively treating those detected with high-risk cancers may be one approach which eliminates potential health care waste while allowing men who develop aggressive cancers to be detected and receive treatment.”
To learn more about treating prostate cancer in early stages, watch below:
Trogdon JG, Falchook AA, Basak R, Carpenter WR, Chen RC. Total Medicare costs associated with diagnosis and treatment of prostate cancer in elderly men [published online September 13, 2018]. JAMA Oncol. doi: 10.1001/jamaoncol.2018.3701.