Men’s Health feature: The $6 Million Dollar Gland

Jim Thornton’s story is about prostate cancer screening.  The six million dollar figure refers to the cost of screening for and treating prostate cancer.  Excerpt:

“At $1,000 or more per biopsy, the cost to U.S. health care for prostate biopsies alone is estimated to run into the billions each year. Whenever cancer is found, expenses escalate even more ferociously: Surgery and hospitalization for a radical prostatectomy, for example, can easily top $13,000—more for men who opt for robot-assisted prostatectomies, today’s sexy new “nerve-sparing” variation on open surgery.

External beam radiation is in the same ballpark. At $200 million proton-beam centers, a course of proton therapy–another trendy new fix that claims to target the tumor and little of the surrounding tissue—is pricier still, costing more than $30,000 per patient. A 2011 study in the Journal of Urology suggests that it costs $5.2 million to prevent a single death from prostate cancer detected via PSA screening.”

His is an artful story, leading with a personal reflection:

“By most standards, it’s fair to describe my family line as being riddled with prostate cancer—the disease has struck my dad and uncle along with all my older male cousins. It’s also true that none of us has ever died of it or even suffered much in the way of symptoms. This is not to say we haven’t suffered.”

And towards the end, he reveals his own personal decision – the kind of story we rarely hear in journalism – of someone who chose a less aggressive but thoughtful path:

“I’ve made peace with the fact that avoiding the PSA test may one day cause me to die of prostate cancer, perhaps quite painfully. This decision is the right one for me, even though it contains the seeds of possible regret.”

But in between he informs and educates about the evidence, the debate, and the money surrounding prostate cancer screening.  He allows both critics and advocates to have a voice in the story.

Please note:  I’ve written in the past asking whether journalists reporting on themselves in health care news amounts to narcissism. The point I made was: “we see many stories by health care journalists reporting about themselves.  They are often imbalanced, incomplete, non-evidence-based stories.”  That was not the case with Thornton’s story.  I also wrote a followup – “First person health care stories not always narcissism – and can be a public service,” and I believe Thornton’s work was a public service.

You may disagree.  But I hope that any dialogue about this issue could be conducted on the basis of evidence, not emotion – of data, not anecdote – of what we can prove rather than solely on what we wish were true.


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Tim Bartik

April 16, 2013 at 2:34 pm

It should be noted that the dramatic $6 million or $5.2 million figure for treatment costs per life saved assumes that the European study’s figure of 48 additional men treated per life saved is valid (the figure comes from a 2011 Journal of Urology article by Shteynshlyuger and Andriole).. But this figure based on the European study is based on an average follow-up of only 9 years. If one uses the European study’s figures, but then simulates what is likely to happen based on the likelihood that prostate cancer deaths increase over time, the “number needed to treat” drops dramatically. For example, articles by Gulatai, Gore, Etzioni and others find “numbers needed to treat” (NNT) of around 3 to 7 men (see Annals of Internal Medicine, February 2013; and Journal of Clinical Epidemiology, 2011, which explicitly references the $5.2 million figure study). These lower NNT would roughly speaking, lower the cost per life saved from $5.2 million to considerably below $1 million. The Gulati/Gore/Etzioni figures are also based on the European study, but make the more plausible assumption that as time goes on, the number of prostate cancer deaths averted will increase.

In other words, such dramatic figures for the high costs of prostate cancer treatment per life saved only apply with the European data if you assume that the effectiveness of prostate cancer treatment does not vary with a longer time horizon than 9 years, which seems implausible.