Real-world use of piflufolastat F 18 and imaging-associated treatment patterns in early-stage prostate cancer.

Abstract

e17126 Background: Positron emission tomography (PET) imaging with piflufolastat F 18, a PSMA-targeted radiotracer for prostate cancer (PCa), has shown value in clinical trials, but real-world use remain underexplored. The objective of this retrospective observational study was to examine the utilization of piflufolastat F 18 among patients with low- to intermediate-risk PCa and evaluate subsequent treatment patterns. Methods: Patients with PCa from community urology practices were identified from the PPS Analytics electronic health record database and restricted to those having ≥1 imaging scan between June 2021–August 2024, a Gleason score of 6 or 3+4 within 6 months of imaging, and no biochemical recurrence. Patients were grouped into two cohorts: (1) those imaged with piflufolastat F 18, and (2) those who only received conventional imaging. Time-to-event outcomes were assessed using Kaplan-Meier analysis. Results: A total of 1,274 patients were included in the piflufolastat F 18 cohort and 25,869 in the conventional imaging cohort. Mean (SD) age was 71.5 (8.4) in the piflufolastat F 18 cohort, and 67.9 (8.1) in the conventional imaging cohort. Gleason score 6 was observed in 53.7% of the piflufolastat F 18 cohort and 59.4% of the conventional imaging cohort, and Gleason score 7 (3 + 4) was observed in 46.3% and 40.6%, respectively. Those imaged with piflufolastat F 18 were more likely to receive treatment during follow-up (74.7% vs. 44.7%) and less likely to undergo active surveillance (5.7% vs. 26.7%). They more frequently received androgen deprivation or hormonal therapy (69.6% vs. 37.3%) and novel hormonal therapy (14.7% vs. 0.3%). In contrast, conventional imaging patients more often underwent prostatectomy (45.3% vs. 23.2%) or radiation therapy (42.0% vs. 35.8%). The piflufolastat F 18 cohort also had fewer follow-up imaging scans (20.7% vs. 39.5%) and a longer median time to next imaging (28.1 vs. 26.3 months). Conclusions: In this cohort of early-stage patients with PCa, imaging with piflufolastat F 18 demonstrated different treatment patterns and follow-up imaging rates compared to conventional imaging. These results suggest that piflufolastat F 18’s may impact clinical decision-making and resource use. Future studies should examine longer-term outcomes following initial piflufolastat F 18 imaging. Treatment patterns and time to next imaging after piflufolastat F 18 vs conventional imaging in low- to intermediate-risk prostate cancer. Piflufolastat F 18 (N = 1,274) Conventional Imaging (N = 25,869) Treatment, n (%) 952 (74.7) 11,563 (44.7) ADT or hormonal therapy 663 (69.6) 4,311 (37.3) Novel hormonal therapy 140 (14.7) 38 (0.3) Prostatectomy 221 (23.2) 5,234 (45.3) Radiation 341 (35.8) 4,852 (42.0) Active Surveillance, n (%) 73 (5.7) 6,917 (26.7) Time to next imaging Events, n (%) 264 (20.7) 10,212 (39.5) Median (months), [95% CI] 28.1 [24.6, NR] 26.3 [25.4, 27.4]