Main Session
Sep
29
PQA 06 - Genitourinary Cancer, Gynecological Cancer, and Health Care Access and Engagement
3271 - Impact of Prostate-Specific Membrane Antigen Scans on Treatment Decision-Making in Patients with Metastatic Prostate Cancer in Clinical Practice: A PRostatE Cancer dISease observatION (PRECISION) Database Analysis
Presenter(s)
Xiao Wei, MD, MAS - Dana-Farber Cancer Institute, Boston, MA
D. J. George1, N. Shore2, E. I. Heath3, X. X. Wei4, J. Nguyen5, J. Patel5, A. Sawhney5, B. Kang5, C. Byrne6, C. Spencer6, and O. Sartor7; 1Department of Medicine, Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 2START Carolinas/Carolina Urologic Research Center, Mrytle Beach, SC, 3Mayo Clinic, Rochester, MN, 4Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 5Novartis Pharmaceuticals Corporation, East Hanover, NJ, 6Asclepius Analytics, New York, NY, 7Medical Oncology Department, East Jefferson/LCMC Health, New Orleans, LA
Purpose/Objective(s):
Prostate-specific membrane antigen (PSMA)-targeted imaging contributes to the assessment of disease burden in patients with metastatic prostate cancer (mPC) and can help to guide treatment selection, particularly for [177Lu]Lu-PSMA-617 (177Lu-PSMA-617). The aim of this study was to assess the rate of PSMA scans among patients with mPC since approval of the first PSMA-targeted radioactive diagnostic agent in 2020, and to evaluate associations between scan use and changes in disease assessment and clinical management. Materials/Methods: This was a retrospective, real-world cohort study using data from PRECISION, a harmonized dataset on patients with mPC in the US from diverse settings. Adult men with an mPC diagnosis between 01/01/2020 and 06/27/2025 were included. Analyses were performed in all patients as well as subgroups with hormone-sensitive (mHSPC) and castration-resistant mPC (mCRPC), which could overlap. The index dates were the dates of mPC, mHSPC, and mCRPC diagnosis, respectively. Patient characteristics and PSMA scan utilization in the 1–5 years pre- and post-index were evaluated. Clinician-documented disease progression and new treatment initiation were assessed over the 90 days post-scan among patients with =1 scan. All analyses were descriptive.Results:
A total of 55,427 patients with mPC were included in the study (49,794 with mHSPC, 14,107 with mCRPC). The median age was 73 years; 66% were managed in urology settings and 34% in oncology settings at index. Among all patients, 16,990 (31%) had =1 PSMA scan at any point, 64% of whom had 1, 24% 2, and 12% =3 scans in total. In the mHSPC and mCRPC subgroups, 30% and 38%, respectively, had =1 PSMA scan. The rate of PSMA scan utilization increased over time, with 13% of all patients in 2020 and 46% in 2024 receiving =1 scan (2025 rate projected to be =50%). Scan utilization was observed most often in the 1 year pre- (13%) and post-diagnosis (14%). Overall, 59% of assessable patients (1,151/ 1,942) had a new clinician-documented progression and 37% initiated a new treatment within 90 days of a PSMA scan. Among new treatments initiated in the mCRPC subgroup, 177Lu-PSMA-617 represented 30%. Over 80% of patients in the mCRPC subgroup initiating 177Lu-PSMA-617 had =1 repeat PSMA scan within 2 months of initiation; 98% did so over the subsequent year.Conclusion:
These results demonstrate rapid uptake of PSMA imaging utilization for assessment of patients with mPC, with almost half of patients receiving =1 scan in 2024, the most recent complete year of the study. In the majority of cases, PSMA scans appeared to have a meaningful effect on clinical decision-making, with substantial proportions of patients having a new documented progression and/or starting a new treatment post-scan.