Variations in PSMA PET utilization, PSA testing, and urologist involvement in advanced castrate resistant prostate cancer: Comparing academic and community practices in the US.

Abstract

e17075 Background: Advanced prostate cancer management has evolved with the adoption of PSMA PET imaging and refined PSA monitoring. However, real-world utilization of these tools may differ between specialists involved and also between academic and community settings. This study examined trends and variations in PSMA PET use, PSA testing, and urologist involvement across practice types when treating mCRPC patients. Methods: Data were extracted from the Ipsos Global Oncology Monitor, a physician-reported online medical chart review of cancer patients receiving drug therapy. All reported patients with metastatic castration-resistant prostate cancer (mCRPC) needed to be currently treated with anti-cancer drug therapy (i.e. hormonal, chemotherapy, PARP inhibitors, immuno-oncology agents, radioligand therapy). We evaluated clinical characteristics, co-management patterns, PSMA PET and PSA testing, and risk profiles of mCRPC patients managed in US academic vs. community practices from Jul ‘22 to Sept. ‘24. The latest 12 months of data (Oct ’23 to Sept ’24) included 201 patients from academic and 593 from community settings reported by 53 and 184 physicians, respectively. Results: Between Jul ’22 and Sept ’24 urologist co-management with medical oncologists increased from 11% to 25% overall (p<0.01) and 24% to 37% in community practices (p<0.05). Focusing on the latest datapoint, Oct ’23 to Sept ’24, we observed that medical oncologists were more likely to use PSMA testing (78% vs. 55%, p<0.01) and ordered monthly PSA testing more frequently than urologists (57% vs. 13%, p<0.01). These differences may be driven by urologists being more involved in hormonal-only therapy over hormonal with chemotherapy prescription (66% vs. 47%, p<0.01). Community-based physicians reported treating a higher proportion of high-risk patients (63% vs. 56%), which may contribute to the higher proportion of PSMA-positive patients in community settings (52% vs. 34%, p<0.01), particularly among medical oncologists (76% vs. 45% for urologists, p<0.01). This trend may also reflect varied thresholds for interpreting scans, with community physicians more inclined to classify equivocal findings as positive. Conclusions: This real-world study highlights that differences exist in PSMA PET and PSA testing practices for mCRPC patients, both between specialists and between academic vs. community settings. Further research is needed to elucidate the reasons behind variations in PSMA PET positivity rates and scan interpretations by Specialist and by Practice type. With rising urologist involvement, targeted education is crucial to harmonize evidence-based management across specialties and settings.