Black Men in US Have Highest Mortality for Prostate Cancer While Treatment Costs Increase

Two different studies report that in the US, Black men had an estimated 70% to 110% higher incidence and mortality rate for prostate cancer than White men overall, while Medicare costs for treatment of metastatic prostate cancer have risen sharply within the last 15 years.

New findings led by researchers at the American Cancer Society (ACS) found that in addition to the higher incidence and mortality rates for Black men with prostate cancer, the highest mortality rates for prostate cancer in White men were found in the Western region of the United States. The study, published in European Urology, also showed persistent sociodemographic disparities and unfavorable trends in incidence or mortality for all four major genitourinary cancers (bladder, kidney, prostate, and testicular) for men and women in the US.

“These data are a call to arms. Prostate cancer can be readily treated and eradicated when detected in early stage, yet this cancer type persists as the second leading cause of cancer death amongst men in the United States. Moreover, overall trends show a deeply concerning shift toward diagnosis of later stage disease. We can and must do more,” said Dr. Karen E. Knudsen, ( chief executive officer at the American Cancer Society and senior author of the study. “This study reveals striking geographic and racial disparities that should be studied and mitigated. Our data identify a significant burden on a subset of populations, including men in the West and Black men overall.  ACS is committed to being part of the change, toward advancing prevention programs, early detection of disease, and better medical treatment and care for prostate cancer.”

For this study, researchers analyzed incidence rates for bladder, kidney, prostate, and testicular cancers in the U.S. from the Surveillance, Epidemiology, and End Results (SEER) Database at the National Cancer Institute (NCI), mortality rates from the U.S. Cancer Statistics database from the Center for Disease Control and Prevention, and the National Center for Health Statistics (NCHS). They examined cross-sectional and temporal trends in incidence and death rates stratified by sex, race/ethnicity, and county. Age-adjusted incidence and death rates were calculated by the NCI’s SEER Stat software and temporal trends were analyzed using the Joinpoint Regression Program.

Other key findings from the study:

  • Geographically, the highest incidence rates among White individuals were found in the Northeast for bladder cancer and in Appalachia region and parts of the south for kidney cancer.
  • Incidence rates increased for bladder cancer in American Indian and Alaska Native individuals.
  • For testicular cancer, incidence rates increased in all racial and ethnic groups, while mortality rates increased only in Hispanic men.
  • Mortality rates stabilized for prostate cancer among White and Asian American/Pacific Islander men, after a steady decline since the early 1990s.

In the Medicare cost study published in Urology Practice, researchers used data from the SEER-Medicare database to assess trends in treatment costs for metastatic prostate cancer. The analysis included 30,489 male fee-for-service Medicare beneficiaries aged 66 years or older with prostate cancer diagnosed between 2007 and 2017. About 21% of the men were initially diagnosed with metastatic prostate cancer, while 79% had primary prostate cancer that progressed following diagnosis.

"Our study shows rapid increases in the cost to Medicare per-patient and total annual costs, corresponding with the approval and adoption of newer, more costly drugs for metastatic prostate cancer," comments senior author David H Howard, PhD, of Rollins School of Public Health, Emory University, Atlanta.

Cost data were compared to those of a group of 216,000 men not diagnosed with prostate cancer during the same time period. In both groups, average age was about 76 years. Medicare expenses were collected for both groups for claims between 2007 and 2019.

Average annual Medicare spending was $45,391 for men with metastatic prostate cancer, compared to $16,906 in men without prostate cancer (all figures in 2019 dollars). Average costs were lower for patients initially diagnosed with metastatic disease, compared to those with later metastases: $40,471 versus $47,029.

With adjustment for demographic and health-related factors, men with metastatic prostate cancer incurred average additional costs of $31,427 per year. About one-third of the difference ($8,756) was due to spending on drugs under Medicare Part D.

Annual per-patient costs increased substantially during the study period: from $28,311 between 2007 and 2013 to $37,055 between 2014 and 2017. This trend – and particularly the increase in Medicare Part D costs – was attributed to the introduction of several new treatments for metastatic prostate cancer, such as radium-223, sipuleucel-T, abiraterone, and enzalutamide. Although these novel therapies are effective, they are more expensive than previous treatments, with many costing close to $10,000 per month.

The proportion of men receiving the chemotherapy drug docetaxel – before 2010, the only effective treatment for patients who do not respond to hormone-blocking (androgen deprivation) therapy – decreased from 14.7% in 2007 to 6.1% in 2017. Meanwhile, the use of newer treatments grew rapidly: use of the novel hormonal therapies abiraterone and enzalutamide increased from 5.1% in 2010 to 26.0% in 2017.

Overall annual health costs attributable to metastatic prostate cancer were estimated at $5.2 billion (based on Medicare reimbursement rates) to $8.2 billion (based on private insurance reimbursement rates). "These figures probably understate current costs because they were based on our analysis of data from 2012 to 2019," Dr Howard and coauthors note.

The US incidence of metastatic prostate cancer has increased in recent years, possibly reflecting recommendations against routine prostate cancer screening with prostate-specific antigen. "Metastatic prostate cancer is associated with substantial per-patient and aggregate health care costs," Dr Howard and colleagues conclude. "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."

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