The Facts:
• Prostate cancer is the most common cancer in the United States and second most lethal cancer in men.
• 2 million American men are currently living with prostate cancer.
• Prostate cancer (striking 1 in 6 men) is more common than breast cancer (1 in 8 women).
• A man is diagnosed with prostate cancer every 2.5 minutes.
• A man dies every 18 minutes, even though prostate cancer can be cured when detected early.
Prostate cancer is not recognized as a national priority and major health care disparity.
• National funding for prostate cancer research lags far behind investments in breast cancer research (see NCI Funding and DOD Funding). As a direct result, men do not have accurate diagnostic tools akin to life-saving mammograms.12
• AUA and US Preventive Task Forces advises against the routine PSA screening for men however, these guidelines don’t apply to men at high-risk including those with a positive family history of cancer and African-American roots.
What does this mean?
• Unreliable diagnostic tools result in blind patient care, a national patient care crisis and socio-economic problem.
• Under-diagnosis leads to missed and/or underestimated cancer, lost lives,3 treatment failures and progression of cancer in as many as 1 in 2 men.4
• Over-diagnosis causes unnecessary biopsies in as many as 88% of men (over 1,000,000 men) each year2 and unnecessary treatment in as many as 54% of men with early, benign disease. 5
• Men experience reduced quality of life due to treatment complications, such as incontinence and impotence.6
• Billions of dollars are added to health care costs every year.7
1. Andriole GL, et al. New England Journal of Medicine 2009; 360(13): 1310-1319.↩
2. www.cancer.gov/cancertopics/factsheet/detection/plco-prostate.↩
3. Robert KA, et al. Journal of Urology 2002; 167(6): 2435-2439.↩
4. AdMeTech’s Public Conference, September 2007.↩
5. Miller DC, et al. Journal of the National Cancer Institute 2006; 98: 1134-1141.↩
6. AdMeTech’s Public Conference, September 2007.↩
7. AdMeTech’s Brain Trust, April 2007.↩
8. H.Gilbert Welch, Peter C. Albertsen. Journal of the National Cancer Institute 2009; 101(19): 1325-1329.↩
Solution: Advanced Imaging Technologies
Consensus Statement
AdMeTech convened a Consensus Conference in 2009, which brought together over 40 leaders of medicine, government, industry, and advocacy and concluded the following:
“We firmly believe that more accurate imaging technology would lead to better patient care, including guidance for diagnosis, biopsy and minimally-invasive therapy. Real and important improvements in prostate cancer care are at hand if we are resolved to increase the national investment in prostate diagnostics.”
Emerging Scientific Evidence
Current data indicate that imaging technologies may detect prostate cancer missed with current diagnostics, including biopsy.
MRI detects early, small cancer (red) in the prostate (green) before it spreads to the surrounding organs.
Advanced MRI can now make it possible to provide precisely targeted, minimally-invasive guidance for biopsy and removal of cancer.
Expected Impact
In the same way that mammography transformed breast cancer care, advanced prostate cancer imaging will:
• Save lives;
• Improve early diagnosis, which is critical for cure;
• Enable the least invasive and the most effective care;
• Decrease treatment complications and discomfort;
• Eliminate unnecessary procedures;
• Improve quality of life in millions of men;
• Reduce health care costs by at least $5 billion annually
Cost Savings
Advanced Imaging Technologies will save an estimated $5.04 billion per year
1) Unnecessary Biopsies: $1.44 Billion
Currently, the yield of prostate cancer with blind biopsies is 12% per NCI study. In practical terms, if we had 240,000 new cases diagnosed in 2006 (mostly due to abnormal PSA), it means that about 2 Million biopsies were performed. The costs of all biopsies would be $4 Billion.
Assumption #1: Imaging procedures will increase cancer yield to even as low yield as 25%. Then we would have decreased the number of biopsies to 960,000 per year, with the related costs of $1,920,000. Thus, the cost savings would be $2.08 Billion.
Assumption #2: Every man with abnormal PSA (2 million, as above) will have imaging screening procedure, with estimated cost of at least $200 per optical and/or ultrasound imaging. The additional cost to health care will be 400 Million.
Assumption #3: Each man diagnosed with prostate cancer on biopsy will have diagnostic MRI (for staging and aggressiveness assessment), with estimated cost of $1000 per procedure. The additional cost to health care will be $240 Million.
Net Estimated Saving to Health Care: $2.08 Billion – ($400 Million for imaging screening plus $240 Million for imaging diagnostics) = $1.44 Billion
2) Unnecessary Treatment: $1.6 Billion
Assumption #1: Conservatively estimated, 25% of men with prostate cancer currently undergoing radical surgery or radiation would benefit from active surveillance, and the unnecessary treatment results in health care costs of $2 Billion (25% of the annual costs of $8 Billion).
Assumption #2: The cost of treatment is at least $20,000. Current available data: The cost of radical surgery is about $20,000-$30,000 national average; and the cost of standard radiation treatment is $20,000, while the cost of IMRT is about $40,000 – 50,000.
Assumption #3: Each man who will undergo active surveillance instead of treatment will have MRI procedure per year for 4 years (in addition to the original diagnostic procedure counted above). At $1000 per procedure, this will bring the additional cost of MRI to $4,000 per patient, or 20% of the lowest costs of treatment, or $400 Million (compared to est. $2 Billion, as above).
Net Estimated Cost Savings: $2 Billion – 400 Million = $1.6 Billion
3) Transition from Current Methods of Treatment to Minimally-Invasive Procedures: $2 Billion
Assumption #1: The cost of minimally-invasive procedures is 50% of the current treatment (the worst case scenario). Per published data, the cost of minimally-invasive procedures is estimated at about 25% to 50% of standard radiation and radical surgery.
Assumption #2: With earlier diagnosis and improved localization with imaging, we will replace at least 50% of current standard treatment with minimally-invasive procedures.
Net Estimated Cost Savings: $2 Billion (compared to the current $8 Billion per year)
4) Total Estimated Annual Savings to Health Care: $5.04 Billion per year