External beam radiation therapy (EBRT) and radical prostatectomy (RP) are definitive options for patients with localized or locally advanced prostate cancer (LPC). Limited evidence exists on the post-treatment economic burden in these patients.
This real-world analysis investigated healthcare costs among Medicare beneficiaries with LPC who received EBRT or RP as initial definitive treatment.
This is a retrospective, longitudinal cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Included were Medicare Fee-For-Service beneficiaries newly diagnosed with LPC at the age of ≥65 years during 2012-2019 and received either EBRT or RP as an initial definitive therapy. After the initial therapy, all-cause and prostate cancer-related costs were summarized and stratified by the earliest observed definitive therapy (RP vs EBRT) and the National Comprehensive Cancer Network risk classification (low/intermediate-risk [LIR-LPC] vs high-risk [HR-LPC]).
Of the 17 066 LPC patients treated with EBRT, 60% (N =10 321) had LIR-LPC and 40% (N = 6745) had HR-LPC. During the follow-up, the mean per-person-per-year all-cause cost was 9837 h i g h e r i n t h e H R - L P C c o h o r t t h a n t h e L I R - L P C c o h o r t ( 34 441 vs $24 604; P < .0001). Of the 9479 patients treated with RP, 43% (N = 4120) had LIR-LPC and 57% (N = 5359) had HR-LPC. The mean per-person-per-year all-cause cost during follow-up was 6829 h i g h e r i n t h e H R - L P C c o h o r t t h a n t h e L I R - L P C c o h o r t ( 23 820 vs $16 991; P < .0001). Across all cohorts, the largest all-cause healthcare cost category was outpatient, followed by inpatient and prescription drug.
This real-world study on healthcare costs in patients with LPC treated with EBRT or RP showed HR-LPC is associated with significant incremental economic burden relative to LIR-LPC. The findings highlight the current unmet need for more cost-effective treatment strategies for HR-LPC.
Journal of health economics and outcomes research. 2026 Jul 29*** epublish ***
Lawrence Karsh, Shawn Du, Jinghua He, Neal Shore, Kruti Joshi
AdventHealth Urology, Denver, Colorado, USA., Johnson & Johnson, Horsham, Pennsylvania, USA., Carolina Urologic Research Center, Myrtle Beach, South Carolina, USA.