Disparities in receipt of molecular imaging in biochemical recurrent prostate cancer.

Abstract

297 Background: Molecular imaging with novel radiotracers is changing treatment landscape in prostate cancer (PCa). Currently, standard of care includes both conventional and molecular imaging, leaving uncertainty in prescription decision. This study evaluated the determinants of and disparities in utilization of molecular imaging for biochemical recurrent (BR) PCa. Methods: This is an observational, single institution, cohort study within the University of California, San Francisco (UCSF). Data were obtained on all men with BR PCa seen at UCSF from June 2018 to May 2019, regardless of histologic subtype. Multivariate logistic regression models were employed to analyze the primary outcome: receipt of molecular imaging (e.g. Fluciclovine PET, Prostate Specific Membrane Antigen PET) as part of diagnostic work-up for BR PCa. Multivariate linear regression models were used to analyze the secondary outcome: overall healthcare cost (hereafter cost) within a one-year time-frame. Results: The study sample included 245 patients; 88% non-Hispanic White (White), 2 % non-Hispanic Black (Black), 9% Asian/Pacific Islander (Asian), and 10% Other. The majority were 55 years or older (66%) and privately insured (73%). Analysis indicated that a one unit reduction in PSA is associated with 1.4 times higher likelihood of receiving molecular imaging (p<0.01). Analysis found that privately insured patients experienced approximately $500,000 more in cost (p<0.01) as compared to the publicly insured. Additionally, a one unit increase in PSA is associated with $5,075 increase in cost (p<0.05). Correlations between race and imaging type and having received radical prostatectomy (RP) and imaging type were identified but were not statistically significant (p<0.10). Conclusions: Higher PSA was associated with lower likelihood for molecular imaging and higher cost in a one year time-frame. Higher cost was also associated with private insurance, but there was no clear relationship between insurance type and imaging type. This study identified several factors – which may impact prescription pattern – that are worth exploring within a larger patient sample; namely, race/ ethnicity and RP as determinants for receipt of molecular imaging.