UPJ INSIGHT: The Cost of Metastatic Prostate Cancer in the United States

By: T. Anders Olsen, MD; Christopher P. Filson, MD, MS; Thomas B. Richards, MD; Donatus U. Ekwueme, PhD, MS; David H. Howard, PhD | Posted on: 02 Feb 2023

Olsen TA, Filson CP, Richards TB, Ekwueme DU, Howard DH. The cost of metastatic prostate cancer in the United States. Urol Pract. 2023;10(1):40–47.

Figure. Histogram comparisons of ureteroscope (URS) times for Moses and thulium fiber laser (TFL). Mean, median (interquartile range) URS time for Moses = 21.4, 20 (11-28) minutes. Mean, median (interquartile range) URS time for TFL = 19.9, 17 (13-24) minutes. Mann-Whitney U P value = .6.

Study Need and Importance

Since 2010, the U.S. Food and Drug Administration has approved a number of new treatments for metastatic prostate cancer. Many cost close to $10,000 per month. We sought to describe the per patient and total costs incurred by patients with metastatic prostate cancer using Surveillance, Epidemiology, and End Results-Medicare data.

What We Found

Average annual Medicare spending among beneficiaries with metastatic prostate cancer was $45,391 and adjusted attributable spending was $31,427 (2019 dollars). We estimate that total annual spending was $5.2 to $8.2 billion. The Figure shows spending for beneficiaries with metastatic prostate cancer and control group beneficiaries. Annual spending in the cancer group increased from $45,672 in 2007 to $54,737 per year in 2018.


Our study had 3 major limitations: (1) reliance on claims data to identify beneficiaries with metastatic disease, (2) the sample is limited to fee-for-service Medicare beneficiaries ages 66 and older, and (3) cost differences between men with metastatic prostate cancer and the control group may be biased by baseline differences in health status.

Interpretation for Patient Care

Metastatic prostate cancer is associated with substantial per patient and aggregate health care costs. These should be taken into account when prioritizing biomedical research funds and assessing the value of interventions, like screening, to reduce the incidence of late-stage disease.