High-risk localized prostate cancer is associated with substantially worse clinical outcomes and elevated healthcare expenditures following radical prostatectomy, according to a major real-world analysis of U.S. patient data.
Researchers examined electronic medical records and administrative claims from January 2016 through August 2024. The study included 18,971 men who underwent surgery, stratified by National Comprehensive Cancer Network criteria. Of these, 7,542 were classified as high-risk, while 11,429 fell into low or intermediate-risk categories.
The survival disparity was stark. At 36 months post-surgery, metastasis-free survival stood at 90.2% for the high-risk cohort, compared to 97.3% for those with lower-risk disease. This gap widened over time, with high-risk patients facing a hazard ratio of 3.80 for metastasis or death. By 60 months, event-free survival dropped to 50.8% for high-risk patients, versus 80.7% for their counterparts.
The economic burden mirrored the clinical trends. Analysis of a cost subgroup revealed that mean total all-cause healthcare costs reached $42,952 per patient annually for high-risk cases, compared to $33,818 for low or intermediate-risk cases. This $9,134 annual difference was driven primarily by outpatient expenses, underscoring the persistent financial strain on patients even after potentially curative intervention.