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Prostate Cancer

Men who had repeated PSA tests before diagnosis got surgery. Men who had none got hormone therapy

45.6 percent against 33.8 percent for surgery; 42.3 against 59.7 percent for hormone therapy. The cost difference came from how long the systemic treatment ran, not from its monthly price.

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In short

In a nationwide Korean insurance cohort of 166,848 men newly registered with prostate cancer between 2010 and 2020, of whom 26.7 percent had repeated prostate-specific antigen testing before registration and 42.2 percent had none, localised treatment was substantially more common after repeated testing (surgery 45.6 against 33.8 percent, radiotherapy 17.0 against 14.9 percent, focal therapy 0.8 against 0.3 percent, all p < 0.001) while systemic treatment predominated without it (hormone therapy 59.7 against 42.3 percent, chemotherapy 2.7 against 1.0 percent, androgen receptor-targeted agents 1.4 against 0.5 percent, all p < 0.001), and the higher cumulative spending in the untested group reflected longer treatment duration rather than higher monthly cost.

Key takeaways

  • 166,848 Korean men newly registered with prostate cancer between 2010 and 2020 were analysed from national insurance data.
  • 26.7 percent had been PSA-tested at least three times across at least two years before registration; 42.2 percent had not been tested; 31.1 percent were undetermined.
  • Surgery was the initial treatment for 45.6 percent of the tested group against 33.8 percent of the untested group (p < 0.001).
  • Hormone therapy was used in 59.7 percent of the untested group against 42.3 percent of the tested group (p < 0.001).
  • Chemotherapy (2.7 against 1.0 percent) and androgen receptor-targeted agents (1.4 against 0.5 percent) were both more common without prior testing.
  • Per-patient costs of non-robotic surgery and radiotherapy were comparable between the groups for treatment delivered from 2016 to 2020.
  • Spending on hormone therapy and androgen receptor-targeted agents was significantly higher in the untested group, driven by longer treatment duration rather than higher monthly spending.

The argument about prostate-specific antigen screening is usually conducted in terms of mortality, where the evidence is genuinely contested. This study asks a narrower question that the same data can actually answer: among men who did get prostate cancer, what difference did it make whether anyone had been testing them beforehand?

The split in what was done to them

45.6% vs 33.8%

share receiving surgery as initial treatment — men with repeated PSA testing before diagnosis, against men with noneKo YH et al., Investigative and Clinical Urology, 2026

Every localised modality was more common in the tested group and every systemic one was more common in the untested group, and the gaps are wide. Hormone therapy ran at 59.7 percent without prior testing against 42.3 percent with it. Chemotherapy was almost three times as frequent, androgen receptor-targeted agents almost three times again.

Localised therapy is what is offered to cancer confined to the prostate. Systemic therapy is what is offered when it is not. The treatment distribution is, in effect, a stage distribution reported through the claims system — and it says the untested men arrived with more advanced disease.

The money, and where it actually went

The cost analysis was confined to 2016 to 2020, when government-set prices had stabilised, which removes the most obvious confounder in a decade-long price comparison. For localised modalities — non-robotic surgery and radiotherapy — per-patient costs were comparable between the two groups. The difference sat entirely in the systemic arm.

What this does not establish

It does not show that PSA screening saves lives. Survival is not an endpoint here, and the men who get repeatedly tested differ from the men who do not in every way that health-seeking behaviour differs — income, education, urban residence, having a regular doctor. Any of those could produce the same treatment split without PSA doing any work at all.

What it does establish is narrower and harder to argue with: in Korean practice, the presence or absence of prior testing tracks a large, consistent difference in what treatment a man receives and for how long. Read alongside the finding that roughly half of Korean prostate cancer is high-risk at diagnosis, the two point at the same gap from opposite directions.

Sources

  1. 1

    Ko YH, Kim SW, Son NH

    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

    Investigative and Clinical Urology 2026;67(3):263-272

    doi:10.4111/icu.20250537 · PMID:42065662

    https://doi.org/10.4111/icu.20250537