Elsevier

Urology

Volume 76, Issue 3, September 2010, Pages 703-707
Urology

Prostate Cancer
Cost Comparison Between Watchful Waiting With Active Surveillance and Active Treatment of Clinically Localized Prostate Cancer

https://doi.org/10.1016/j.urology.2009.12.071Get rights and content

Objectives

In part because of concern regarding overtreatment in men with prostate cancer, watchful waiting with active surveillance (WWAS) has been increasingly used in men diagnosed with low-risk prostate cancer. The present study investigates the difference in costs between men with low-risk prostate cancer treated with up-front radical prostatectomy (RP) versus WWAS.

Methods

A cost model was constructed using data from centers that have published their results in men who were followed up with WWAS compared with the actual costs of up-front RP calculated from a high volume center. Two WWAS arms of 15-year duration were created in which the follow-up protocol and conversion rate to active treatment were varied.

Results

The cost of up-front RP including costs of surgery, complications, and follow up for 15 years was $15 235 per person. Costs of WWAS were estimated using annual conversion rates from WWAS to RP of both 5% and 7%. Costs per person in the WWAS arms ranged from $6558 to $11 992 in the scenarios created which represent a 43%-78.7% reduction in costs when compared with men undergoing up-front RP.

Conclusions

Watchful waiting with active surveillance is being increasingly used in hopes of decreasing the potential overtreatment of prostate cancer in men with low-risk disease. The present study suggests that WWAS is likely to markedly decrease costs when compared with active treatment with RP.

Section snippets

Material and Methods

Models were created to calculate the costs for both active treatment and WWAS. Given the long natural history of prostate cancer, all models calculated costs over a 15-year period. The model assumes that men diagnosed with prostate cancer who choose active therapy will undergo radical prostatectomy (RP). Men undergoing RP were assumed to present for follow up every 3 months the first year after RP, every 6 months in years 2-5 after RP, and then annually for years 6-15. The costs of an office

Results

The costs calculated for WWAS and up-front RP are summarized in Table 2. Costs are reported as costs per patient. The cost per patient for the WWAS arms ranged from $6558 to $11 992. Costs were increased by longer active follow-up (active follow up referring to ongoing serial prostate biopsy), more frequent prostate biopsies, and a higher rate of conversion to active treatment. Costs per person for the WWAS protocols ranged from 43% to 78.7% of the up-front RP costs per person.

For men in the

Comment

Prostate cancer screening remains a controversial issue. The benefits of prostate cancer screening have not yet been proved in a randomized, prospective trial. However, the risks of treatment resulting from screening-detected prostate cancer are well known, and include the possibility of erectile dysfunction and urinary incontinence. It is becoming increasingly clear that a portion of screening-detected prostate cancer is clinically insignificant and does not represent a threat to survival.

Conclusions

Watchful waiting with active surveillance is being increasingly used in the hope of decreasing the overtreatment of prostate cancer in men with low-risk disease. The present study demonstrates that WWAS is likely to decrease costs when compared with up-front active treatment with RP. These decreased costs are largely caused by the avoidance of active therapy in some patients and by the delay of active treatment in others. As studies of WWAS mature, criteria for entry into WWAS protocols and

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