3385 - Effect of PSMA PET/CT Image Review as a Visual Navigation Aid in a Vulnerable Prostate Cancer Population
Presenter(s)
K. Subramanian1, A. Shakir2, X. Xie3, R. Kim4, W. R. Bodner III5, M. K. Garg6, and J. Tang7; 1Montefiore Medical Center, Bronx, NY, 2Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States, 3Department of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 4Albert Einstein College of Medicine, Bronx, NY, 5Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, 61Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 7Department of Radiation Oncology, Montefiore Einstein Cancer Center, Bronx, NY
Purpose/Objective(s): Significant racial and socioeconomic disparities exist in prostate cancer outcomes, particularly in underserved urban areas. Decisional conflict and low health literacy regarding complex treatment paradigms (RT vs. surgery vs. ADT) are major barriers to timely care. This study evaluates a Quality Improvement (QI) initiative utilizing PSMA PET/CT imaging as a visual navigation aid to enhance patient empowerment and shared decision-making (SDM) in a vulnerable population.
Materials/Methods: A prospective and retrospective program evaluation at an urban tertiary center where men with unfavorable intermediate to very high-risk prostate cancer were evaluated. Patients were stratified into two cohorts: PSMA PET (imaging completed prior to and reviewed at initial radiation oncology consult; n=53) and no PSMA PET (n=22). Validated tools included the 5-item Cancer Empowerment Scale (CES) and the 3-item CollaboRATE survey. Statistical comparisons utilized two-sample t-tests after checking the normal distribution assumption with Shapiro-Wilk test for the continuous baseline characteristic and Chi-square tests/Fisher’ exact tests for the categorical variables. Linear mixed effects models were fitted with the survey scores as the response variable, the cohort groups as the binary predictor of interest, transportation assistance and insurance type as the confounders, and patient-level random intercept for correlation among the repeated observations of same patients. Median Time to treatment initiation (TTI), defined as the time from PET imaging to the first treatment among radiation, hormone therapy and surgery, was estimated by Kaplan-Meier method. Cox proportional hazards model was used to assess the difference in TTI between the cohorts.
Results: Baseline characteristics were well-balanced between groups, including age (mean 68.8 vs. 68.5, p=0.86), risk stratification (p=0.29), and insurance type (p=0.47). The population demonstrated significant medical complexity, with high rates of hypertension (70–77%) and diabetes (27–32%). Linear mixed-effects modeling revealed no significant difference in empowerment or SDM scores. Mean CollaboRATE scores remained high across both cohorts (7.35–7.95), suggesting a high institutional standard for SDM. A notable, nonsignificant trend was observed such that patients who reviewed imaging before their encounter had a longer median TTI (41 vs. 14 days; HR 0.57, 95% CI: 0.31-1.06; p=0.07).
Conclusion:
Our analysis demonstrates that while advanced molecular imaging adds significant diagnostic clarity, it does not enhance CES or SDM in this medically complex and socioeconomically vulnerable urban population. Instead, the consistently high CollaboRATE scores (7.35–7.95) across both cohorts suggest that a robust institutional culture of patient engagement can absorb new, complex technologies without alienating the patient.