OBJECTIVES: Economic data in prostate cancer (PC) is limited to advanced metastatic stages. As treatments have evolved, there is a need for updated cost burden data. This study describes the total cost burden of PC over time by disease stage.

METHODS: We conducted a retrospective, observational cohort study of patients enrolled in the US-based Optum® Clinformatics Data Mart database between January 2015 to December 2021. Participants were male, aged ≥ 18, with a diagnosis of PC, and were divided into subgroups by disease stage: localized PC; biochemically recurrent (BCR)/non-metastatic hormone-sensitive PC (nmHSPC); non-metastatic castration-resistant PC (nmCRPC); metastatic hormone-sensitive PC (mHSPC); and metastatic castration-resistant PC (mCRPC). Annual all-cause costs of care for each disease stage subgroup were determined prior to and following the index year (2018). Costs included all PC-related diagnostic, treatment, laboratory, hospital, pharmacy, and procedural claims. Costs were adjusted to 2022 US dollars using the Medical Consumer Price Index to account for inflation. All analyses are descriptive and exploratory.

RESULTS: The median cost of care was highest for metastatic disease (mCRPC $77,378 [IQR 27,967, 138,976]; mHSPC $73,210 [35,139, 125,086]), followed by localized PC ($31,237 [9,139, 56,728]), BCR/nmHSPC ($26,166 [8,722, 55,887]), and nmCRPC ($9,007 [3,612, 29,948]). Maximum costs were observed in the year of stage identification (mCRPC, mHSPC, and localized PC) or the year before (nmHSPC and nmCRPC). Costs showed a lower trend in the subsequent three years, metastatic disease trended higher than non-metastatic disease: localized PC ($5,952, $5,644, $4,158); BCR/nmHSPC ($7,138, $6,598, $4,597); nmCRPC ($5,958, $7,816, $4,512); mHSPC ($25,868, $12,712, $3,895); mCRPC ($38,368, $12,517, $9,284).

CONCLUSIONS: PC treatment incurs high costs generally while metastatic PC accrues the highest cost burden, irrespective of hormone sensitivity. These data support the need for appropriate management strategies to optimize potential delay of disease progression, including effective screening, diagnosis, and early intervention.