Rising out-of-pocket costs for prostate cancer diagnostics burden patients, new study reveals

A new study published in CANCER, a journal of the American Cancer Society, reveals that men with elevated PSA screening results face substantial and rising out-of-pocket costs for additional diagnostic tests. This financial burden, which includes copayments, coinsurance, and deductibles, may deter patients from necessary screenings, potentially affecting early detection and treatment of prostate cancer.

To investigate the extent of such financial burdens, researchers analysed information on 3,075,841 US privately insured men ages 55 to 69 years- old who underwent PSA screening in 2010–2020. Among these men, 91,850 had a second PSA test and an elevated PSA, of which 40,329 (43.9 per cent) underwent subsequent diagnostic testing.  

 Among the men who underwent subsequent testing, more than 75 per cent experienced out-of-pocket costs. The median out-of-pocket costs rose substantially over the years of the study for patients undergoing biopsy only ($79 to $214), imaging only ($81 to $490), and imaging plus biopsy ($353 to $620). 

 In 2023, the American Cancer Society published a statement asserting that cancer screening is a multistep process, stressing that payers must eliminate out-of-pocket costs for all necessary diagnostic tests. “In the context of prostate cancer, this means that insurance companies should provide full coverage for imaging, prostate biopsy, and other recommended testing, if indicated by an abnormal prostate cancer screening test,” said lead author Dr Arnav Srivastava, MD, MPH, of the University of Michigan, Ann Arbor.

“We have seen this strategy successfully implemented in colorectal cancer screening, as part of a new addition to the Affordable Care Act. Thus, we recommend that policymakers and insurance companies offer full coverage for testing throughout the screening pathway and eliminate cost-sharing for patients,” he added.

This study was led by Dr Arnav Srivastava, Anca Tilea, Dr David D Kim, Dr Vanessa K Dalton, and Dr A Mark Fendrick.