Detection and treatment of prostate cancer: perspective of the urologist

We examine changes in the detection and treatment of prostate cancer from the perspective of the urologist. There has been an extraordinary increase in the incidence of prostate cancer (60% from 1990 to 1993). We calculated, based on data from the literature and assumptions about changes in urological practice, that 52% of newly diagnosed cases would be treated by radical prostatectomy in 1993. Extrapolating from the work of Catalona, we derived the number of office consultations, prostate biopsies and orchiectomies associated with the diagnosis and treatment of these tumors. Applying Health Care Financing Administration reimbursements to our figures, we calculated that each urologist would realize $45,370 for prostate cancer care in the Medicare population in 1993. If all patients 50 to 70 years old were screened by American Cancer Society and American Urological Association recommended algorithms, this projection would be $107,919. Despite this enormous economic impact of prostate cancer on the urologist, uncertainties remain concerning the appropriateness of screening and treatment for this disease. Only increased funding for basic research in prostate cancer will resolve these uncertainties.