Is Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Imaging Cost-effective in Prostate Cancer: An Analysis Informed by the proPSMA Trial

Cardet, Rafael E. de Feria; Hofman, Michael S; Segard, Tatiana; Yim, Jackie; Williams, Scott; Francis, Roslyn J.; Frydenberg, Mark; Lawrentschuk, Nathan; Murphy, Declan; Lourenço, Richard De Abreu

doi:10.1016/j.eururo.2020.11.043

Cited by 62 publications

(37 citation statements)

References 14 publications

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“…According to the available data and the foreseeable increase in PSMA PET use before primary treatment, it stands to reason that future inclusion of PSMA PET within the main international guidelines can be expected, at least in a setting of high-risk PCa at disease presentation. Moreover, a cost-effectiveness analysis developed using data from the proPSMA study demonstrated greater accuracy and lower direct comparative costs for PSMA PET than for conventional imaging, namely CT and bone scanning (28).…”

Section: Stagingmentioning

confidence: 99%

Current and Emerging Clinical Applications of PSMA PET Diagnostic Imaging for Prostate Cancer

et al. 2021

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Prostate-specific membrane antigen (PSMA) is highly expressed on most prostate cancer (PCa) cells, and several PSMA ligands for PET imaging are now available worldwide. 68 Ga-PSMA-11 has already received U.S. Food and Drug Administration approval, and use of PSMA PET is currently suggested by several international guidelines for investigating PCa in different clinical settings. In primary PCa, PSMA PET has been shown to be superior to cross-sectional imaging for the detection of pelvic lymph nodes and distant metastases with subsequent clinical management changes. Additionally, it might also have a role in intraprostatic tumor localization, especially when combined with multiparametric MRI. In a setting of PCa recurrence, higher detection rates have been observed than for any other available imaging techniques, especially at low prostate-specific antigen values. Furthermore, PSMA PET consistently led to a shift in clinical management, thus increasing the proportion of radiotherapy, surgery, or other focal therapies at the expense of systemic options or no treatment. In oligometastatic disease after radical surgery, PSMA PET may be relevant in guiding a metastasis-directed therapy approach, as preliminary data seem to suggest a benefit in terms of progression-free survival after treatment of PSMA PET-positive lesions. As a staging and gatekeeping technique, PSMA PET represents a reliable wholebody imaging procedure in combination with second-line therapy of castration-resistant PCa, as well as being pivotal when assessing patients eligible for radioligand therapy such as 177 Lu-PSMA. This critical review aims at providing a comprehensive overview of the latest literature on the current or emerging main indications, as well as a general outlook on the recommended interpretation criteria for PSMA PET imaging.

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Section: Stagingmentioning

confidence: 99%

Current and Emerging Clinical Applications of PSMA PET Diagnostic Imaging for Prostate Cancer

et al. 2021

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“…A cost-effectiveness analysis was recently conducted using data from the proPSMA trial [4] . From an Australian societal perspective, PSMA PET is the dominant strategy, with both better accuracy and lower costs, compared to the standard of care.…”

mentioning

confidence: 99%

Prostate-specific Membrane Antigen Positron Emission Tomography, Not Conventional Imaging, Should Be Performed for Primary Staging of High-risk Prostate Cancer

Ceci

Musi

Cobelli

2021

European Urology Open Science

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“…However, in this case Australia’s regulatory policies have clearly allowed the advantage of early adoption and widespread access of a valuable diagnostic modality. In a cost-effectiveness analysis of the proPSMA study, PSMA PET was modeled to be more cost effective than CT and bone scans in the Australian setting ( 17 ). Similarly, in Germany, a permissive regulatory environment has fostered an environment favoring innovation in PSMA based theranostics, however, there is variable access to these agents both by indication and by jurisdiction ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Establishing a Provincial Registry for Recurrent Prostate Cancer: Providing Access to PSMA PET/CT in Ontario, Canada

et al. 2021

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Prostate Specific Membrane Antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is becoming established as a standard of care for the (re)staging of high-risk primary and prostate cancer recurrence after primary therapy. Despite the favorable performance of this imaging modality with high accuracy in disease detection, the availability of PSMA PET/CT varies across jurisdictions worldwide due to variability in the selection of PSMA PET/CT agent, regulatory approvals and funding. In Canada, PSMA based radiopharmaceuticals are still considered investigational new drug (IND), creating limitations in the deployment of these promising imaging agents. While regulatory approval rests with Health Canada, as a single payer health system, funding for Health Canada approved drugs and devices is decided by Provincial Health Ministries. Ontario Health (Cancer Care Ontario) (OH-CCO) is the agency of the Ministry of Health (MOH) in Ontario responsible for making recommendations to the MOH around the organization and funding of cancer services within Ontario (population of 15 million), and the PET Steering Committee of OH-CCO is responsible for providing recommendations on the introduction of new PET radiopharmaceuticals and indications. For Health Canada approved PET radiopharmaceuticals like 18F-FDG, OH-CCO (on behalf of the MOH) provides coverage based on levels of evidence and specific PET Registries are established to aid in real-world evidence collection to inform OH-CCO regarding emerging PET applications. In the case of PSMA PET/CT, adapting this model to an IND PSMA PET/CT agent, 18F-DCFPyL, necessitated the creation of a hybrid Registry-Study model to leverage the existing OH-CCO Registry structure while respecting the need for a Health Canada Clinical Trials Application (CTA) for the deployment of this agent in the province. Within the first 2 years of the registry, over 1700 men have been imaged resulting in a change in management (compared to pre-PET management plans) in over half of the men imaged. In this article, we describe the organization and deployment of the PSMA PET/CT (PREP) Registry throughout the province to provide access for men with suspected prostate cancer recurrence along with key stakeholder perspectives and preliminary results.

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Is Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Imaging Cost-effective in Prostate Cancer: An Analysis Informed by the proPSMA Trial

Cited by 62 publications

References 14 publications

Current and Emerging Clinical Applications of PSMA PET Diagnostic Imaging for Prostate Cancer

Current and Emerging Clinical Applications of PSMA PET Diagnostic Imaging for Prostate Cancer

Prostate-specific Membrane Antigen Positron Emission Tomography, Not Conventional Imaging, Should Be Performed for Primary Staging of High-risk Prostate Cancer

Establishing a Provincial Registry for Recurrent Prostate Cancer: Providing Access to PSMA PET/CT in Ontario, Canada

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