A generation of boomer men is in the crosshairs for an explosion in prostate cancer and therapy, especially in the U.S. where incidence is already widespread and over-treatment has become a serious subject of debate among experts.
As more boomers — those born between 1946 and 1964 — move through their 50s and 60s, the number of new cases of prostate cancer alone is expected to rocket upward to 300,000 a year by 2015, according to National Institute of Health. More than 218,000 American men were diagnosed with prostate cancer last year, with 32,000 dying from it.
Today, about two million men are fighting prostate cancer. But as boomer men reach the target age range for prostate cancer over the next decade, another three million more men may join the statistics.
Prostate as Profit Center
Those numbers make treatment of prostate cancer and disease a booming business. The New York Times reported in 2009 that the average cost in the U.S. for prostate surgery was $23,000, proton therapy $100,000 and targeted high-dose radiation therapy up to $50,000, according the RAND Corporation data. Yet those are averages. Surgeries can range over $64,000 and high-dose radiation treatment can reach the $100,000 mark.
These eye-popping price tags for treatment go up with the rising costs of newer treatment technologies and their delivery systems. For example it typically costs between $125 million and $225,000 million to build new state-of-the-art proton therapy centers, which are about the size of two football fields. Imaging costs are doubling in comparison to the overall cost of cancer care.
The new vaccine Provenge is going for about $93,000 for treatments, and sales are expected to reach $1.5 billion a year. This drug isn't a cure; it helps men with advanced cancer to extend their lives an average of four months.
PSA Test Controversy
PSA screens are under fire as an over-used test among the elderly with non-life threatening prostate cancer. The annual bill for the screening is about $3 billion, much of it paid by Medicare and the Veterans Administration. Add in the billions more for drugs, doctor visits and surgeries for treating BPH and prostatitis as well as cancer, and the prostate gland is an enormous profit center for health care providers.
Most patients, of course, never see the bill for these treatments — they are paid for in the form of higher health insurance premiums. Moreover, because of the advanced age when prostate cancer afflicts most men, the cost of cutting-edge treatments like Image-Guided Radiation Therapy, da Vinci robotic surgery, and proton therapy weigh heavily on the solvency of the Medicare system.
This isn't to say that these treatments aren't needed and welcomed by men in distress. They certainly are. But many elderly men have harmless, Stage 1 cancers — they don't need therapy, they're ideal watchful waiting candidates — yet they're still receiving costly high-tech treatments.
Overtreatment Concerns
In the New York Times article, A Device to Kill Cancer, Lift Revenue, high-dose radiation therapy is targeted as an overused therapy. A 2006 study in the Journal of the National Cancer Institute is cited that found 45% of American men with prostate cancer who received external radiation were being overtreated. There are similar statistics for over-treatment with surgeries.
With millions of boomer men moving through their prostate years, it's no wonder over diagnosis and over-treatment of prostate cancer are becoming topics of huge concern. Many wonder if treating older men with slow growing, non-life threatening prostate cancer with exorbitantly expensive technology may sabotage the health system all by itself.
Watchful Waiting for Low-grade Cancer
Harvard Professor David Cutler, a Research Associate at the National Bureau of Economic Research and a member of the Institute of Medicine, is one of them. He calls the prostate treatment problem "the poster child for overused care."
In a 2010 paper for the NBER cited in the Incidental Economist, Professor Cutler writes that while "almost all elderly men have cancer of the prostate," clinical evidence shows that the therapies are "approximately equally efficacious in men aged 65 and older" for localized prostate cancer, including watchful waiting.
In other words, doing nothing — except monitoring slow-growing cancer — is just as effective as surgery or radiation, but without the risk of side effects from an aggressive treatment. Professor Cutler cites new research that says the health care delivery system would save "$1.7 to $3.0 billion annually" if all Medicare patients received guideline-concordant care.
Agreeing on these guidelines within medical circles may be trickier than finding a good screen for prostate cancer. Still, whether older men need expensive treatments is something that must be sorted out with better screening and risk evaluations by physicians. Otherwise, the real financial costs of treating the prostate in an aging boomer population may implode.
Sources
- Patrick Walsh, Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer, Wellness Center, 2007.
- Ben Org, All About the Prostate, The Nutrition and Health Institute, 2009.
- Larry Clapp, Ph.d., Prostate Health in 90 Days without drugs or surgery, Hay House, Inc., 2007.
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