LOCALIZED prostate cancer risk stratification predicted poorer survival and higher healthcare costs after radical prostatectomy.
Localized Prostate Cancer Outcomes Differ By Risk
High-risk localized prostate cancer was associated with substantially worse clinical outcomes after radical prostatectomy compared with low or intermediate-risk disease in a large real-world U.S. analysis. The retrospective study used linked electronic medical records and administrative claims from January 2016 through August 2024 to assess men with localized prostate cancer who underwent radical prostatectomy in routine urology practice.
The clinical outcomes population included 18,971 patients, with 7,542 classified as high risk and 11,429 classified as low or intermediate risk. Risk groups were defined using tumor node metastasis staging, prostate-specific antigen levels, and Gleason score, in alignment with National Comprehensive Cancer Network criteria. After inverse probability of treatment weighting, baseline characteristics were generally balanced between cohorts.
At 36 months after radical prostatectomy, metastasis-free survival was 90.2% in the high-risk cohort versus 97.3% in the low or intermediate-risk cohort. High-risk disease was associated with a markedly higher rate of metastasis or death at 36 months, with a hazard ratio of 3.80. This elevated risk persisted at 60 months, when metastasis-free survival was 84.3% versus 95.1%, respectively.
Healthcare Costs Increased After Radical Prostatectomy
Event-free survival showed an even sharper separation between risk groups. At 36 months, event-free survival was 57.8% in the high-risk cohort and 85.0% in the low or intermediate-risk cohort. By 60 months, these rates were 50.8% and 80.7%, respectively. High-risk localized prostate cancer was linked to significantly higher rates of biochemical recurrence, metastasis, or death at both time points.
Economic outcomes followed the same pattern. In the cost subgroup, 1,488 patients with high-risk disease and 2,572 with low or intermediate-risk disease were analyzed. During the observation period, mean total all-cause healthcare costs were $42,952 per patient per year in the high-risk cohort versus $33,818 in the low or intermediate-risk cohort, a difference of $9,134. Prostate cancer-related costs were also higher, at $31,256 versus $23,753 per patient per year.
Outpatient costs drove much of the cost difference, while medical costs accounted for nearly all prostate cancer-related spending during the localized prostate cancer period. The findings highlight the continued clinical and economic burden faced by patients with high-risk localized prostate cancer, even after potentially curative surgery.
Reference
Shore N et al. Real-World Clinical and Economic Outcomes Among Patients with Localized Prostate Cancer Undergoing Radical Prostatectomy Across Different Risk Stratifications in the United States. ClinicoEconomics and Outcomes Research. DOI: 10.2147/CEOR.S590934.
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