Abstract
BackgroundMolecular imaging with novel radiotracers is changing the treatment landscape in prostate cancer (PCa). Currently, standard of care includes either conventional and molecular imaging at time of biochemical recurrence (BCR). This study evaluated the determinants of and cost associated with utilization of molecular imaging for BCR PCa.MethodsThis is a retrospective observational cohort study among men with BCR PCa from June 2018 to May 2019. Multivariate logistic regression models were employed to analyze the primary outcome: receipt of molecular imaging (e.g. Fluciclovine PET and Prostate Specific Membrane Antigen PET) as part of diagnostic work‐up for BCR PCa. Multivariate linear regression models were used to analyze the secondary outcome: overall healthcare cost within a 1‐year time frame.ResultsThe study sample included 234 patients; 79.1% White, 2.1% Black, 8.5% Asian/Pacific Islander, and 10.3% Other. The majority were 55 years or older (97.9%) and publicly insured (74.8%). Analysis indicated a one‐unit reduction in PSA is associated with 1.3 times higher likelihood of receiving molecular imaging (p < 0.01). Analysis found that privately insured patients were associated with approximately $500,000 more in hospital reimbursement (p < 0.01) as compared to the publicly insured. Additionally, a one‐unit increase in PSA is associated with $6254 increase in hospital reimbursement or an increase in total payments by 2.1% (p < 0.05).ConclusionsHigher 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.
Highlights
Molecular imaging with novel radiotracers is changing the treatment landscape in prostate cancer (PCa)
In the era of precision medicine, emerging use of novel radiotracers such as 68-Gallium Prostate Specific Membrane Antigen (PSMA) and 18-Fluciclovine positron emission tomography (PET) has led to an enhanced ability to characterize the extent of disease in men with low volume biochemical recurrence (BCR) PCa.[4]
Fluciclovine PET was approved by the United States Food and Drug Administration in May 2016,5 and by extension became covered for the Medicare insured by 2017.6 Wider availability of such molecular imaging modalities has recently been recognized to create a “stage shift” in PCa,[7] identifying metastatic disease in cases that would be considered non-metastatic based on conventional imaging
Summary
Prostate cancer (PCa) is the second leading cause of cancer-related deaths among men in the United States.[1]. Characterizing the extent of disease in the setting of BCR may lead patients to more intensified hormonal therapy with androgen signaling inhibitors combined with androgen deprivation therapy (ADT) and consideration of metastases-directed therapy or targeted radiation to oligo-metastases.[8] clinical trials are increasingly incorporating molecular imaging modalities into screening and surveillance protocols. Whether these technologies are utilized equitably by race/ethnicity and other social factors is poorly understood. This study sought to identify factors that best predict receipt of molecular imaging in the context of BCR PCa leveraging a real-world data set
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