Advanced prostate cancer: course, care, and cost implications.

Background: If prostate cancer screening proves to be effective, some cases will be prevented from reaching the advanced stage. In order to evaluate screening programs thoroughly, it is important to quantify course, care, and accompanying costs of advanced disease.
Methods: We studied 70 files of patients in two hospitals, who had received a diagnosis of distant metastases of prostate cancer and who had died in the years 1994-1998. The total healthcare received by these patients, including symptoms and complaints, was recorded.
Results: The most frequently reported symptoms were pain (42%), urogenital symptoms (25%), and malaise (20%). Eighty-nine percent of all patients were hormonally treated (either by orchidectomy and/or chemical castration), and 47% received one or more series of radiation therapy. Sixty-nine percent of all patients were treated with pain medication. The average duration of advanced disease in all patients was 24 months. Average costs of advanced disease were estimated at $11,182 over the total period: $1,547 (14%) was allocated to assessment and outpatient care, and $9,635 (86%) to treatment and costs of hospital stay. Almost half of the total costs were determined by hospital stay.
Conclusions: These data give a better understanding of the course, care, and costs of advanced prostate cancer. These estimates, together with the effects of advanced prostate cancer on quality of life, will be used for the evaluation of prostate cancer screening.