Impact of repeated prostate-specific antigen testing on management patterns and personal healthcare spending for prostate cancer: A population-based study National Health Insurance data for 166,848 patients in South Korea from 2010 to 2020

Abstract

Purpose: To evaluate whether repeated prostate-specific antigen (PSA) testing influences treatment patterns and healthcare costs for prostate cancer (PCa). Materials and Methods: We analyzed a nationwide insurance cohort of men newly registered with PCa from 2010 to 2020. Patients were classified as PSA-tested ( >= 3 tests across >= 2 years before registration) or PSA non-tested (first PSA test within 3 months before registration). We compared the initial and subsequent treatment patterns between localized and systemic therapies, and per-patient medical expenditures by treatment modality. The analyses focused on 2016 to 2020, when government-set prices stabilized. Primary endpoints were cumulative medical costs and downstream medical utilization patterns. Results: Of the 166,848 men, 26.7% were PSA-tested, 42.2% were non-tested, and 31.1% were undetermined. Localized therapy was more frequent after repeated testing: surgery, 45.6% versus 33.8% (p<0.001); radiotherapy, 17.0% versus 14.9% (p<0.001); and focal therapy, 0.8% versus 0.3% (p<0.001). Systemic therapy predominated without prior testing: hormone therapy, 59.7% versus 42.3% (p<0.001), chemotherapy, 2.7% versus 1.0% (p<0.001), and androgen receptor-targeted agents, 1.4% versus 0.5% (p<0.001). For localized modalities delivered during 2016 to 2020, the per-patient costs of non-robotic surgery and radiation therapy were comparable between the groups. In contrast, expenditures for hormone therapy and androgen receptor-targeted agents were significantly higher in the PSA non-tested group, primarily reflecting a longer treatment duration rather than higher monthly spending. Conclusions: Once national prices stabilized, repeated PSA testing was associated with greater use of localized therapy and lower cumulative spending on prolonged systemic treatment without increasing the costs for localized modalities.