Disparities in PET imaging for prostate cancer at a tertiary academic medical center

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J Nucl Med. 2020 Sep 25:jnumed.120.251751. doi: 10.2967/jnumed.120.251751. Online ahead of print.

ABSTRACT

18F-fluciclovine and 68Ga-prostate specific membrane antigen (PSMA) are novel PET imaging radiotracers used to characterize disease burden in biochemical recurrent prostate cancer. 18F-fluciclovine was FDA-approved in 2016 and is reimbursed through public and private payers, while 68Ga-PSMA-11 is considered investigational and accessed through clinical trials. The purpose of this study was to evaluate the demographic differences between patients receiving 18F-fluciclovine and 68Ga-PSMA-11 at a tertiary academic medical center. Methods: All 18F-fluciclovine and 68Ga-PSMA-11 PET studies performed at the University of California, San Francisco (UCSF) between October 2015 and January 2020 were reviewed. Age, race/ethnicity, primary language, body mass index, insurance type, and home address were obtained through the electronic medical record database. Home addresses were geocoded to Census Block Group and assigned to neighborhood socioeconomic status (nSES) using a previously described composite measure. A logistic regression model was used to evaluate the association between each of the predictor variables and the type of PET imaging received. Results: This study included 1,756 patients; 1,502 patients received 68Ga-PSMA-11 and 254 patients received 18F-fluciclovine. Black patients had increased odds of receiving imaging with 18F-fluciclovine versus 68Ga-PSMA-11 compared to non-Hispanic white patients. (OR 3.88, 95% CI 1.90-7.91,). There were no statistically significant differences in other patient demographics between the two groups. Conclusion: In patients receiving molecular imaging for prostate cancer at a single U.S. tertiary medical center, access to 68Ga-PSMA-11 for Black patients was limited, compared to non-Hispanic white patients, by a factor of nearly four.

PMID:32978283 | DOI:10.2967/jnumed.120.251751