Economics of prostate cancer screening: racial implications

Prostate cancer early detection has progressed rapidly within the last decade, producing significant new insights to the disease and escalating its yearly incidence to the most commonly diagnosed cancer in men. These rapid developments in diagnostic technology also appear to be challenged by the need for cost-efficacy in the face of dwindling economic resources. This paper attempts to summarize some recent advances in prostate cancer detection in relation to cost-efficacy and their potential racial implications. The American Cancer Society-National Prostate Cancer Detection Project (ACS-NPCDP) demonstrated a very cost-effective strategy for biopsy reduction, producing up to 50% reductions in total screening costs by increasing overall specificity by only ≈5%. While the ACS-NPCDP had one of the highest participations by African American men at only 7%, adequate comparison with the general population did not have sufficient statistical power. Important preliminary data of clinical detection in a large cohort of African American men suggest that greater numbers of more clinically relevant cancers can be found more easily with prostate-specific antigen and quality transrectal ultrasound evaluation than in Caucasians. Racial differences in prostate cancer substantiate the need for re-evaluating detection issues in high-risk men and their impact on designing future health care programs. Endocrine-Related Cancer (1996) 3 199-203