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Rates of PSMA PET Staging and Positivity in Newly Diagnosed Prostate Cancer in a National Health Care System - Beyond the Abstract

Prostate specific membrane antigen (PSMA) PET scans recently gained approval from the United States FDA in 2020 for staging newly diagnosed prostate cancer. Given the increased sensitivity and specificity of these scans as compared to conventional staging imaging, clinicians rapidly implemented them into routine practice. However, the impact of these scans on a national scale was unknown. We reported the rates of PSMA PET staging for all newly diagnosed prostate cancer patients across the Veterans Health Administration (VHA) as well as rates of positivity.

Since the VHA is a single-payer system, once FDA approved, clinicians were not restricted by insurance reimbursement and could order the scan for patients they felt would benefit from improved staging. Therefore, the VHA provided a unique view of clinician discretion for the ordering of PSMA PET scans. We saw a rapid rise in utilization with 70% of patients with high Gleason score and/or baseline PSA being staged with PSMA PET by June 2023 – a remarkable change in clinical practice in only 3 years.

With such high utilization, the next question was – how does PSMA PET change the staging of newly diagnosed prostate cancer patients? In a chart-reviewed cohort, rates of upstaging from conventionally localized disease to PSMA PET N1 or M1 increased with risk group, from 5.9% of favorable intermediate risk to 34% of very high risk patients. In future work, we plan to explore the impact of this upstaging on clinician treatment decisions and cancer outcomes. This is critically important to understand, as we have shown that these scans are rapidly becoming routine for staging, and yet their impact on patient outcomes is poorly understood.

Written by: Sean Miller, MD1,2 & Alex Bryant MD, MAS1-3

  1. Department of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
  2. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
  3. Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan.

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