(UroToday.com) In a moderated poster presentation at the 2022 American Urologic Association Annual Meeting held in New Orleans and virtually, Dr. Juana Martinez discussed the demographic and socioeconomic characteristics of patients undergoing prostate-specific membrane antigen (PSMA)-PET at a single institution in New York City. It is well noted that PSMA-PET imaging has improved the detection rate of prostate cancer lesions (in the primary staging and biochemical recurrence setting), including in low serum PSA values, and has recently become commercially available. Differences in access to care have been shown to contribute to disparities in prostate cancer outcomes in the United States. Differential access to PSMA-PET might lead to a worsening of inequities.
The authors examined all patients with prostate cancer who underwent a PSMA PET scan between January 2018 and October 2021, based on data from the imaging system. The authors used the patient’s zip code as an alternative measure for socioeconomic status by extracting publicly available 2018 tax return data from the IRS’s website and stratifying into 6 socioeconomic groups: <$25k, $25k-$50k, $50k-$75k, $75k-$100k, $100k-$200k, and $>200k. Ranges with over >20% AGI prevalence were selected as majority for a zip code, which could be assigned to one or multiple levels. The authors further considered the funding mechanism for imaging tests for each patient: clinical trial, cost-recovery study, or commercial. For comparison, the racial makeup of prostate cancer patients at this institution was extracted from the institutional database.
The authors identified a total of 564 PSMA-PET scans that were performed during the study interval. The authors identified that most scans were performed among patients with an AGI of $100,000 to $200,000.
When stratified by race, nearly double the number of African American (AA) patients were enrolled in the research cohort relative to the out-of-pocket and insurance cohorts. Non-White Hispanic/Latino patients were the least likely to pay out of pocket for the scan.
By comparison, the institutional (n=1582) makeup of prostate cancer patients was predominantly non-Hispanic White.
The authors conclude that PSMA PET imaging was most commonly performed on white males (age > 70 year) at this single institution, findings in keeping with the broader published literature. Notably, among those undergoing PSMA-PET at this institution, AA patients were more likely to be scanned as participants in a clinical trial. However, more than 55% of the men in each cohort who underwent PSMA-PET resided in a zip code where over 20% of residents have an annual gross income of over $200,000. This highlights that despite favorable insurance coverage, access is still limited by socioeconomic status, zip code, and race.
Presented by: Juana Martinez, MD, New York, NY