Assessment of racial/ethnic inequities in uptake of PSMA-PET imaging among patients with metastatic prostate cancer in the United States.

Abstract

e13739 Background: Prostate-Specific Membrane Antigen–Positron Emission Tomography (PSMA-PET) imaging has transformed the diagnosis and treatment of prostate cancer (PCa) since 2020 because it can detect smaller PCa lesions earlier than conventional imaging methods. Racial/ethnic inequities in PCa are well documented; yet, little is known about the extent of inequities in PSMA-PET use in patients (pts) with PCa. We examined PSMA-PET uptake among non-Latinx/Hispanic White (NHW), Black (NHB), and Latinx/Hispanic pts with metastatic (met) PCa (mPCa) to identify racial/ethnic differences in PSMA-PET use. Methods: This retrospective study included adults diagnosed with mPCa between December 2020 and May 2024 from the US nationwide Flatiron Health electronic health record-derived, deidentified database. Receipt of PSMA-PET was determined by manually reviewing unstructured EHR data. We selected NHW and NHB pts using race/ethnicity-stratified random sampling, to detect an absolute difference of ≥7% in the proportion of pts with a PSMA-PET scan (80% power, α = 0.05). Due to limitations in cohort size, Latinx pts were included in exploratory analyses. To assess the relationship between race/ethnicity and PSMA-PET uptake, we used multivariable logistic regression adjusted for age and mPCa diagnosis year. Socioeconomic status (SES), a mediator, was excluded as a covariate per the Institute of Medicine framework. Results: The cohort consisted of 550 pts: 250 NHW pts, 250 NHB pts, and 50 Latinx pts. More than half (54.0%) of pts had at least 1 documented PSMA-PET scan, with steadily increasing PSMA-PET utilization observed between 2021 (33.3%) and 2023 (64.9%). Compared with NHW pts, NHB pts and Latinx pts were more likely to have a lower SES. NHB pts were also more likely to be younger than NHW and Latinx pts. The majority (88.9%) of initial scans were completed after the met diagnosis date, with 75.0% of scans occurring in the hormone-sensitive setting compared with 24.7% in the castration-resistant setting. Compared with NHW pts, NHB pts had lower PSMA-PET utilization rates (61.2% vs. 50.0%; adjusted [adj] OR, 0.56 [95% CI, 0.38-0.82]). PSMA-PET utilization rates were also lower among Latinx pts (38.0%) relative to NHW pts (adj OR, 0.37 [95% CI, 0.19-0.71]). Conclusions: We observed racial/ethnic differences in the use of PSMA-PET among pts with mPCa. NHB and Latinx pts were less likely to receive PSMA-PET imaging than NHW pts. Our results are consistent with prior research documenting racial/ethnic inequities in the adoption of medical innovations and highlight the need for interventions to promote equitable uptake of diagnostic tools in oncology. Future research should explore potential drivers of racial/ethnic differences in PSMA-PET uptake and their potential impact on pt outcomes.