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Prostate-specific membrane antigen PET/CT cost-effective versus conventional imaging

European Urology
Reuters Health - 28/12/2020 - Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) provides better accuracy than conventional imaging at a lower cost, researchers in Australia say.

"This result was not surprising, given the greater accuracy of PSMA-PET/CT and the reduction in time involved for scan acquisition," Dr. Richard De Abreu Lourenco of the University of Technology Sydney told Reuters Health by email.

"This is an important finding that is applicable elsewhere, (given) that the same radiotracer has recently been approved by the FDA," he said. "While healthcare costs vary between countries, the findings of improved accuracy and shorter time to acquisition are transferable."

For their cost-effectiveness analysis, published in European Urology, Dr. De Abreu Lorenco and colleagues analyzed data from the proPSMA study, which included 302 men with high-risk prostate cancer randomized to conventional imaging or 68Ga-PSMA-11 PET/CT. In that study, PSMA PET/CT was more accurate than conventional imaging in detecting metastatic disease (sensitivity 92%; specificity, 99% vs. 54% and 93%, respectively) and nodal disease (sensitivity 83%; specificity 99% vs. 23% and 96%).

Further, PSMA PET/CT was delivered within an average of 1.5 hours per patient, compared with 5.5 hours for conventional imaging (not including the interval between bone scan acquisitions for CT on separate days).

The proPSMA findings informed the team's decision tree analysis of the cost per accurate diagnosis.

The estimated cost per scan for PSMA PET/CT was AUD$1,203, whereas conventional imaging cost at AUD$1,412, according to the analysis in European Urology.

Overall, use of PSMA PET/CT resulted in a cost saving of AUD$959 per additional accurate detection of nodal disease, and AUD$1,412 saved for additional accurate detection of distant metastases.

"The results were most sensitive to variations in the number of men scanned for each 68Ga-PSMA-11 production run," the authors note. Subsequent research will inform the long-term costs and benefits of PSMA PET/CT-directed care.

Dr. Dominick Lamonica, Director of Nuclear Medicine at Roswell Park Cancer Center in Buffalo, New York, commented in an email to Reuters Health, "The added sensitivity afforded by targeting the extracellular domain of this membrane-based antigen with positron-emitting radioisotopes will change the way we practice medicine."

"It will serve to direct clinicians to the most appropriate form of therapy early on in the patient's disease course and, going forward, to gauge efficacy to permit earlier modification to standard treatment regimens and thereby improve outcomes," he noted. "PSMA -targeted radioisotopic therapy is not far off."

"As with any new image-based technology, cost is of primary concern and will imbue an understandable degree of caution in its adoption by the general medical community.," he said. "My feeling is that the fiscal implications for early modification and optimization of the treatment regimen for this common neoplasm are so profound that they will outweigh a dollar-to-dollar comparison of the use of CT, MRI and bone scan in the upfront staging of patients with intermediate risk disease."

Dr. Savita Dandapani, a radiation oncologist at City of Hope in Duarte, California also commented by email. "The findings definitely will help practice. PSMA has already been shown in trials such as ORIOLE Phase 2 (https://bit.ly/2UDucEF) to affect oligometastatic management. It can detect lesions earlier than conventional imaging, so it can change and guide treatment."

"Sometimes PSMA is too sensitive and can have false positives, so at times doctors will need confirmatory scans or biopsies," she noted. "But these extra steps should decrease as we do more PSMA scans and become more familiar with the process."

SOURCE: https://bit.ly/3hogRda European Urology, online December 16, 2020.

By Marilynn Larkin

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