Utilization, healthcare expenditures, and patient costs of definitive treatment modalities for localized prostate cancer in the United States.
Authors: Sebastian Nikhil , Patil Dattatraya H. , Patel Pretesh R. , Jani Ashesh B. , Hershatter Bruce Warren , Dhere Vishal Ramesh , Godette Karen D. , Weiss Aaron D , Lorentz Charles , Joshi Shreyas , Sanda Martin George , Patel Sagar Anil 
Published: February 2025

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Background:
Radical prostatectomy (RP) and radiotherapy are standard-of-care treatments for localized prostate cancer. We studied the contemporary trends in utilization and costs of prostatectomy and radiotherapeutic modalities in the U.S.
Methods:
We analyzed the MarketScan Medicare Supplemental and Coordination of Benefits (MDCR) and Commercial Claims and Encounters (CCAE) Databases (the latter includes patients insured by employer-sponsored plans). We identified men with non-metastatic prostate cancer treated with RP, external beam radiation therapy (EBRT), brachytherapy (BT), EBRT combined with BT (EBRT+BT), stereotactic body radiation therapy (SBRT), or proton beam therapy (PBT) between 2009 and 2021. Year-to-year utilization of each treatment was compared using Kendall’s Tau-b test. Total healthcare and patient out-of-pocket payments within 12 months following treatment initiation were compared among treatment modalities using the Kruskal-Wallis test.
Results:
In MDCR, we identified 44,937 patients who received treatment with either RP (n=12,879), EBRT (n=26,193), BT (n=926), EBRT+BT (n=4,706), PBT (n=57), or SBRT (n=176). Between 2009 and 2021, the proportion of patients treated with EBRT increased from 52.5% to 62.2% (trend p<0.001), SBRT increased from 0.4% to 0.5% (p<0.001), BT decreased from 3.1% to 1.0% (p<0.001), and EBRT+BT decreased from 14.8% to 6.8% (p<0.001). There was no significant difference in the proportion of patients treated with RP (29.1% vs 29.4%; p=0.82) or PBT (0.1% vs 0.1%; p=0.93). In CCAE, we identified 75,626 patients treated with either RP (n=50,278), EBRT (n=16,985), BT (n=1,243), EBRT+BT (n=6,811), PBT (n=91), or SBRT (n=217). EBRT increased from 20.0% to 24.9% (p<0.001), SBRT increased from 0.1% to 0.8% (p<0.001), BT decreased from 2.5% to 0.7% (p<0.001), and EBRT+BT decreased from 10.6% to 7.4% (p<0.001). There was no significant difference in the proportion of patients treated with RP (66.8% to 66.1%; p= 0.82) or PBT (0.1% vs 0.1%; p=0.76). In both cohorts, PBT had the highest 12-month total and patient costs, while BT had the lowest total cost and SBRT had the lowest patient cost (Table).
Conclusions:
There is increasing use of EBRT and SBRT in the US. Despite BT being the least costly, its utilization, alone or in combination with EBRT, has declined.

Distribution of inflation-adjusted total payments 12 months post diagnosis.

Payment
MDCR
CCAE

RP

EBRT

BT

EBRT+
BT

PBT

SBRT

P

RP

EBRT

BT

EBRT+
BT

PBT

SBRT

P

Total ($) Mean (STD)
30,149 (9,217)
56,199 (19,551)
26,241 (7,920)
38,676 (11,089)
69,719 (17,998)
47,861 (17,377)
< 0.001
35,175 (4,800)
66,940 (11,397)
27,377 (3,707)
45,875 (6,620)
102,312 (12,090)
52,544 (8,027)
<0.001

Patient ($) Mean (STD)
1,102 (255)
1,285 (294)
1,048 (231)
1,287 (299)
1,044 (237)
992 (325)
<0.001
1,965 (671)
1,786 (636)
1,554 (569)
2,031 (695)
1,466 (477)
1,524 (536)
<0.001