Burden of prostate cancer

Abstract

Objective: Increased detection of clinically insignificant prostate cancer with routinely used diagnostic tests, as well as uncertainties in the available treatments to manage the low risk disease, are expected to increase the future burden of the prostate cancer substantially. This study aims to address three major areas in the field of prostate cancer including economic burden, diagnostics, and treatment for low risk disease. Methods: The economic burden of prostate cancer was assessed retrospectively using a population based database. A novel imaging technique such as multiparametric magnetic resonance imaging (MP-MRI) assisted transrectal ultrasound (TRUS) guided biopsy in prostate cancer diagnosis was assessed and compared with the conventional 12-core TRUS guided biopsy by performing a cost-effectiveness analysis. The Surveillance Epidemiology and End Results-Medicare database was used to compare toxicity profiles among localized prostate cancer patients who receive either conservative management or immediate treatment. Results: An annual average total of $5.6 billion was spent on prostate cancer related conditions in 2010 in the United States. Use of chemotherapy and ultrasound increased the expenditure related to outpatient visits significantly; whereas use of ultrasound and x-ray increased office-based visit costs significantly. The MP-MRI strategy was found to be cost-effective compared to conventional TRUS guided biopsy assuming a threshold to pay for is $1781.60. Conservative management was found to have lower odds of urinary, rectal, and erectile complications without compromising the survival within a 5 year time period than the immediate treatment. Conclusion: Routinely used TRUS guided biopsy is associated with a higher economic burden on society. There is a need for tests that can diagnose prostate cancer accurately. MP-MRI/TRUS fusion guided biopsy can characterize prostate cancer accurately and was found to be cost-effective compared to TRUS guided biopsy provided the threshold to pay for this technology is at least $1781.60. To avoid overtreatment among low risk prostate cancer patients, a conservative management approach was found to be a better option because patients can delay or avoid treatment related side effects without compromising prostate cancer specific survival within a 5 year time period.