PROSTATE cancer spending increased substantially between 2012 and 2021, with systemic therapy emerging as the dominant driver of prostate cancer expenditure, according to a population level economic evaluation of Medicare beneficiaries in the United States.
Researchers evaluated prostate cancer related healthcare expenditure between 2012 and 2021 using linked population data from more than 1.2 million fee for service Medicare beneficiaries with histologically confirmed prostate adenocarcinoma.
The study examined annual spending across radiotherapy, surgery, cryotherapy and high intensity focused ultrasonography, systemic therapy, and diagnostic and monitoring services.
During the study period, aggregate prostate cancer expenditure increased almost fourfold, rising from $504 million in 2012 to $1.9 billion in 2021.
Expenditure reached $796 million in 2016 before continuing its upward trajectory through the end of the study period.
The data showed that traditional treatment approaches represented a shrinking proportion of overall spending.
Radiotherapy expenditure remained relatively stable in absolute terms, accounting for $227 million in 2012 and $228 million in 2021, but its share of total spending fell from 45.0% to 12.0%.
Surgery demonstrated a similar pattern, increasing modestly from $53 million to $67 million while declining proportionally from 10.5% to 3.5% of total expenditure.
The most notable shift occurred in systemic therapy spending. Expenditure in this category increased from $142 million in 2012 to $1.4 billion in 2021, representing 74.0% of all prostate cancer related healthcare spending by the end of the study period.
Further analysis revealed that second generation androgen receptor targeted therapy accounted for the majority of this growth. Spending on these agents increased from $46 million in 2012 to $1.2 billion in 2021.
By 2021, they represented 86.6% of systemic therapy expenditure and 64.0% of all prostate cancer related spending.
In contrast, first generation androgen deprivation therapy spending increased more modestly from $57 million to $105 million over the same period.
The findings suggest that prostate cancer management has undergone a substantial shift, with spending increasingly concentrated in prolonged systemic treatment rather than finite local interventions.
Although patients with metastatic disease represented a relatively small proportion of diagnoses, the growing use and duration of systemic therapies appeared to have a significant impact on overall expenditure.
The researchers concluded that systemic therapy has become an increasingly prominent component of prostate cancer care costs.
As treatment strategies continue to evolve, understanding how care is delivered across the disease course will likely be a critical component of future healthcare sustainability discussions.
Reference
Shen J et al. Patterns of health care spending in prostate cancer. JAMA Netw Open. 2026;9(9):e2633031.
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