Systemic Therapy Drives Medicare Prostate Cancer Spending

Prostate cancer–related Medicare expenditures increased from $504 million in 2012 to $1.9 billion in 2021, with systemic therapy accounting for most of the growth, according to a population-level economic evaluation published in JAMA Network Open. Investigators reported that spending shifted particularly toward second-generation androgen receptor–targeted therapies.

The study used linked Surveillance, Epidemiology, and End Results–Medicare data from January 1, 2012, through December 31, 2021. It included fee-for-service Medicare beneficiaries with histologically confirmed prostate adenocarcinoma and prostate cancer–related claims. A descriptive cohort of 1,231,567 beneficiaries enrolled in fee-for-service Medicare at diagnosis had a mean age of 73.2 years.

Annual aggregate expenditures were adjusted to 2017 US dollars and grouped into radiotherapy, surgery, cryotherapy and/or high-intensity focused ultrasonography, systemic therapy, and diagnostic and monitoring services. Systemic therapy spending rose from $142 million, or 28.1% of total expenditures, in 2012 to $1.4 billion, or 74.0%, in 2021.

Radiotherapy spending remained nearly unchanged in absolute terms, increasing from $227 million to $228 million, while its share of total spending declined from 45.0% to 12.0%. Surgery spending increased from $53 million to $67 million, but its share fell from 10.5% to 3.5%. By 2021, second-generation androgen receptor–targeted therapy accounted for $1.2 billion, representing 86.6% of systemic therapy spending and 64.0% of all prostate cancer–related expenditures.

The authors noted that the analysis was limited to fee-for-service Medicare beneficiaries, could not link expenditures reliably to specific disease states or clinical outcomes, and included spending only through 2021. They concluded that systemic therapy had become a dominant component of prostate cancer spending and emphasized treatment duration and advanced disease management in discussions of health care sustainability.

Source: Shen J, Katz AJ, Xie Y, Chen RC, Sayan M. Patterns of health care spending in prostate cancer. JAMA Netw Open. 2026;9(9):e2633031. doi:10.1001/jamanetworkopen.2026.33031