The present study attempts to, quantitate, in an economically and clinicall
y meaningful manner the cost and cost-effectiveness of prostate cancer scre
ening and subsequent treatment, including complications from that treatment
. Outcome data from large prostate cancer screening trials using prostate s
pecific antigen (PSA) and digital rectal examination (DRE) and PSA alone we
re used to construct the screening, model. The benefit of screening is expr
essed in years of life saved by screening, which is calculated by comparing
the survival rate of men with prostate cancer to the survival rate of men
in the general population. The cost of screening, treatment, and complicati
ons, were estimated using the Medicare data base. and published reports on
the cost, morbidity and mortality for radical prostatectomy. The cost per y
ear of life saved by prostate cancer screening with PSA and DRE was $2339-3
005, for men aged 50-59, $3905-5070 for men aged 60-69, and $3574-4627 over
all for men aged 50-69. The cost per year of life saved by prostate cancer
screening with PSA alone for men aged 50-70 was $3822-4956. A sensitivity a
nalysis demonstrates that the cost per year of life saved by prostate cance
r screening will not change substantially even if the assumptions in this,
model have been underestimated or overestimated by 100%. This study quantif
ies only those parameters which can be reliably compared in concrete terms
such as dollars, treatment impact on survival, published complication rates
and published treatment costs. Using this type of analysis, prostate cance
r screening appears to, be a cost-effective intervention. However, the issu
e of whether prostate cancer screening is cost-effective will be decided de
finitively only when randomized, controlled trials are available to quantif
y the costs and benefits, of prostate cancer screening.