Prostate-cancer surveillance - a cost-effective strategy

The intention of a surveillance program to monitor prostate cancer patients is to detect recurrence of disease as soon as possible and institute therapy at the time of recurrence in order to improve the chance of cure or extend survival. We analyzed the cost of four surveillance programs for prostate cancer. As PSA levels are more sensitive than the bone scan, prostatic acid phosphatase and alkaline phosphatase, a surveillance program which utilizes these latter tests provides no additional clinically useful information beyond a PSA level and is costly. Adopting a strategy of eliminating these tests from a surveillance program would reduce national annual expense by approximately $1.5 billion in the year 2000.