OBJECTIVES: To calculate the total per patient cost of prostate cancer (PCa) treatment by stage in the 1st year following diagnosis in 5 European countries. METHODS: IMS Oncology Analyzer (OA), a survey-based data collected from urologists, radiologists, and oncologists between 2002-2006 provided data on diagnostic interventions and initial treatment for 10,576 patients treated in hospitals for UK, Germany, France, Italy and Spain. A costing model combined the data with local expert opinion and published data on resource use and unit costs from published sources to calculate total per patient costs by stage. Diagnostic costs, first surgery, radio- and chemotherapy costs, if any, were included. Cost of 1st-line hormonal therapy, with possibly was also included. Relapse and mortality was factored into the model. Total direct medical costs of initial treatments following diagnosis per patient were calculated for all stages. RESULTS: Majority of men across countries were diagnosed in Stage II. As initial treatment following diagnosis, across all stages, radiation therapy (EBT+brachytherapy) was used most frequently across countries, ranging from 42% (France) to 21.5% (Germany). Use of chemotherapy was low. Total per patient direct costs following diagnosis averaging all stages were €4057, €3256 €3171 (exchange rate conversion), €5226 and €5851 for Germany, Spain, UK, Italy and France, respectively. Surgeries were the largest cost component in all countries except for the UK and Germany. In Germany hormone therapy represents a similar cost to surgery; in the UK where radiation therapy had the highest cost proportion. CONCLUSIONS: In this first study quantifying the cost of PCa treatment in five European countries using similar methods and source across countries found similar total per patient cost estimates, although different treatment patterns and types of costs by country. Given the number of new cases diagnosed in Europe, these estimates suggest a large total spending on the disease.