Patterns of Health Care Spending in Prostate Cancer

Importance Prostate cancer care has evolved substantially during the past decade, with increasing use of systemic therapies across the disease spectrum. How these changes have affected the composition of spending for prostate cancer–related health care remains incompletely characterized. Objective To evaluate temporal trends in prostate cancer–related health care expenditures and identify the major components of care accounting for changes in spending from 2012 to 2021. Design, Setting, and Participants This population-level economic evaluation used Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data from January 1, 2012, to December 31, 2021. The analysis was performed in January 2026. Participants included fee-for-service Medicare beneficiaries with histologically confirmed prostate adenocarcinoma and prostate cancer–related claims during the study period. Exposures Calendar year and category of services for prostate cancer–related health care. Main Outcomes and Measures Annual aggregate prostate cancer–related Medicare expenditures were inflation-adjusted to 2017 US dollars and categorized by radiotherapy, surgery, cryotherapy and/or high-intensity focused ultrasonography, systemic therapy, and diagnostic and monitoring services. Systemic therapy expenditures were further categorized as first-generation androgen deprivation therapy, second-generation androgen receptor–targeted therapy, and other systemic therapies. Results In the descriptive fee-for-service cohort at diagnosis, 1 231 567 beneficiaries were included; the mean (SD) age was 73.2 (7.7) years. Aggregate prostate cancer–related expenditures increased from $504 million in 2012 to $1.9 billion in 2021. Radiotherapy accounted for $227 million (45.0%) in 2012 and $228 million (12.0%) in 2021, reflecting relatively stable absolute expenditures but a declining share of total spending. Surgery accounted for $53 million (10.5%) in 2012 and $67 million (3.5%) in 2021. In contrast, systemic therapy spending increased from $142 million (28.1%) in 2012 to $1.4 billion (74.0%) in 2021. By 2021, second-generation androgen receptor–targeted therapy accounted for $1.2 billion (86.6% of systemic therapy spending and 64.0% of total prostate cancer–related expenditures). Conclusions and Relevance In this economic evaluation of SEER-Medicare data, spending for prostate cancer–related health care increased substantially from 2012 to 2021, with a marked shift toward systemic therapy. These findings suggest that prolonged systemic treatment has become a dominant component of prostate cancer spending and should be central to future discussions of health care sustainability.