According researchers at the Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, prostate cancer screening has little benefit for men 75 years of age and older. However, over three years the Medicare fee-for-service program has spent $447 million annually on PSA based screenings. One third of those screenings were for men over 75 years of age. The study also found considerable geographic variation in the cost of prostate cancer screening.

Many types of prostate cancer are slow growing and unlikely to even become problematic. Widespread screening with serum based PSA tests could even result in unnecessary invasive biopsies, which can potentially be harmful. In 2012, the U.S. Preventative Services Task Force decided to stop recommending PSA screening for men of any age. However, Medicare still continues to reimburse for this test and any subsequent procedures that occur due to the results.

Lead author of the study, Xiaomei Ma, an associate professor at Yale School of Public Health and her Yale COPPER Center colleagues conducted an observational study of older male Medicare recipients who were prostate cancer and other lower urinary tract symptom free at the end of 2006. The researchers followed these men for three years.

In addition to the large Medicare spending for prostate cancer screening in older men, the team found that the costs of prostate cancer screening ranged considerably from around $17 to as high as $62 per beneficiary across different regions. Most of this variation was not a result of the cost of PSA screening itself, but rather to variations in costs of the follow-up tests that needed to be conducted.

“More than 70% of prostate cancer screening related costs were due to follow-up procedures,” said Ma. “Our results suggest that the overall cost of prostate cancer screening may be heavily influenced by how urologists choose to respond to the result of a PSA test, more so than the use of the PSA itself.”

The benefits of prostate cancer screening and treatment are not clear. While men living in high spending regions were more likely to be diagnosed with localized cancers, they were not significantly less likely to be diagnosed with metastatic cancer. This suggests that spending more on screenings might identify more localized tumors, but may not actually reduce the rate of metastatic cancers either.

“In terms of what these results mean for Medicare spending, this is just the tip of the iceberg,” said Cary Gross, M.D., professor of internal medicine at Yale School of Medicine, and director of the Yale COPPER Center. “Many older men who are diagnosed with early-stage prostate cancer may end up receiving therapy that is potentially toxic, has little chance of benefit, and carries substantial cost. In order to truly understand the costs of screening, the next step is to identify how many additional cancers are being diagnosed and treated as a result of screening older men for prostate cancer. We need better tools to target screening efforts towards those who are likely to benefit.”

“In a time when healthcare spending is soaring, it is important to weigh the physical, psychological, and financial burden of cancer screening against the possible clinical benefit,” said Gross, who is a member of the Yale Cancer Center. “The cancer research community needs to continue exploring novel approaches to target prostate cancer screening and treatment efforts, identifying and disseminating strategies that work, and abandoning strategies that don’t work.”

This study was published in the October 4 issue of the journal Cancer.