Out-of-pocket costs from diagnostic testing after prostate cancer screening are common and rising

Prostate-specific antigen (PSA) screening aims to identify men who may harbor potentially lethal prostate cancer, and those with high PSA results often require more extensive (and expensive) diagnostic testing to establish a diagnosis. New research reveals that the out-of-pocket costs for such additional tests are substantial, common, and rising. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

Abnormal screening tests (i.e., elevated PSA) warrant additional testing involving magnetic resonance imaging and/or prostate biopsies. High out-of-pocket costs for these tests-;including copayment, coinsurance, and deductibles-;may not only place a substantial burden on patients, but also may deter patients from going through with recommended screening.

To investigate the extent of such financial burdens, researchers analyzed information on 3,075,841 US privately insured men ages 55–69 years old who underwent PSA screening in 2010–2020. Among these men, 91,850 had a second PSA test and an elevated PSA, of which 40,329 (43.9%) underwent subsequent diagnostic testing.

Among the men who underwent subsequent testing, more than 75% experienced out-of-pocket costs. The median out-of-pocket costs rose substantially over the years of the study for patients undergoing biopsy only ($79 to $214), imaging only ($81 to $490), and imaging plus biopsy ($353 to $620).

In 2023, the American Cancer Society published a statement asserting that cancer screening is a multistep process, stressing that payers must eliminate out-of-pocket costs for all necessary diagnostic tests.

In the context of prostate cancer, this means that insurance companies should provide full coverage for imaging, prostate biopsy, and other recommended testing, if indicated by an abnormal prostate cancer screening test. We have seen this strategy successfully implemented in colorectal cancer screening, as part of a new addition to the Affordable Care Act. Thus, we recommend that policymakers and insurance companies offer full coverage for testing throughout the screening pathway and eliminate cost-sharing for patients."

Arnav Srivastava, MD, MPH, lead author of the University of Michigan, Ann Arbor

This study was led by Dr. Arnav Srivastava, Ms. Anca Tilea, Dr. David D. Kim, Dr. Vanessa K. Dalton, and Dr. A. Mark Fendrick.