Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is currently under evaluation for detecting clinically significant prostate cancer. The PSMA-PET/CT may complement the current standard diagnostic pathway for prostate cancer, which includes prostate-specific antigen (PSA) testing and multiparametric magnetic resonance imaging (mpMRI). This study evaluated the cost-effectiveness and quality of life impact of incorporating PSMA-PET/CT into this diagnostic algorithm.
A life-time decision model compared the current standard of care of a MRI driven diagnostic pathway, where men undergo prostate biopsy in case of a Prostate Imaging Reporting and Data System (PI-RADS) scores 3-5, to a strategy incorporating PSMA-PET/CT to potentially avoid unnecessary biopsies. Long-term quality-adjusted life years (QALY) and healthcare costs were calculated for each approach.
In PI-RADS 3 lesions, PSMA-PET/CT improved the per-patient QALY by 0.002 and was borderline cost-effective, with an increased cost of €170-€186 per patient and an incremental cost-effectiveness ratio (ICER) of €56,700-€93,212 per QALY. In PI-RADS 1-2, additional biopsies and over-detection of low-risk prostate cancers led to a per-patient QALY decrease of 0.001 points, a cost increase of €416-€429 per patient and was thus not cost-effective.
The addition of PSMA-PET/CT to MRI in patients with equivocal MRI findings appears to be borderline cost-effective due to biopsy avoidance and a reduced detection of indolent, low-risk tumors. In men with a negative MRI, adding a PSMA-PET/CT does not seem to be cost-effective due to a higher number of unnecessary biopsies and only minor improvement in the detection of clinically significant prostate cancer.
European journal of nuclear medicine and molecular imaging. 2025 Mar 12 [Epub ahead of print]
Bastiaan M Privé, Tim M Govers, Bas Israël, Marcel J R Janssen, Bart J R Timmermans, Steffie M B Peters, Michel de Groot, Patrik Zámecnik, Stan R W Wijn, Alexander Hoepping, J P Michiel Sedelaar, Jelle O Barentsz, Inge M van Oort, Maarten de Rooij, James Nagarajah
Department of Medical Imaging, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands. ., Department of Medical Imaging, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands., Medip Analytics, Nijmegen, The Netherlands., Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds Gmbh, 1454, Radeberg, Germany., Department of Urology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.