Self-reported race and zip code by men with prostate cancer in New York City and association with access to PSMA PET scans.
Authors: Nauseef Jones T. , Martinez Zuloaga Juana , Subramanian Kritika , Gregos Peter , Bissassar Mahelia , Singh Sharon , Patel Amie , Tan Angela , Getz Ted , Labadie Brian , Dallos Matthew , Sternberg Cora N. , Nanus David M. , Bander Neil Harrison , Huicochea Castellanos Sandra , Margolis Daniel , Osborne Joseph , Tagawa Scott T. 
Published: June 2022

e17007

Background: Prostate-specific membrane antigen (PSMA) is overexpressed on most prostate cancers (PCs), a fact that has been exploited to perform both targeted imaging and treatment. PSMA-based PET imaging allows for more sensitive detection of PC and can be useful even in the context of negative CT and bone scans. Prior to 2021, research protocols using PSMA-PET (PET) were common at large academic centers, but will likely be more commonplace as standard of care (SOC) after recent FDA approval. With a change in SOC imaging, the impact of cost to patients must be examined. We hypothesize that socioeconomic and demographic-based care disparities may widen and access may narrow in the face of these changes. Methods: We collected demographic data on patients with PC from Weill Cornell Medicine (WCM), Brooklyn Methodist Hospital (BMH), and Columbia University Medical Center (CUMC) who received a PSMA PET scan between 1 January 2018 and 31 January 2022. Data collected included age, zip code, primary language, self-reported race and ethnicity, and type of insurance coverage. Zip codes were used to estimate income strata of patients using publicly-available 2018 IRS adjusted gross income (AGIs) as follows ($): < 25k, 25k-50k, 50k-75k, 75k-100k, 100k-200k, and > 200k. Any AGI strata comprising > 20% of population was counted. Patients were divided into four cohorts: those who had a scan (1) as part of therapeutic-based studies for mCRPC, (2) non-therapeutic imaging studies, (3) as a part of a cost-recovery study with an out-of-pocket cost of $1054, and (4) commercial use under post-approval standards of care (SOC) billed to insurance. Proportion of self-reported race in each cohort was compared against overall race distribution for prostate cancer registry from WCM and CUIMC (Table). Results: 896 patients underwent PSMA PET. Approximately half of all scans were in Cohort 4 (49%, n = 368) including all BMH scans. CUMC scans were 90% in Cohort 2 (122/136). In Cohort 1, 2, and 3, > 90% of subjects resided in zip codes with AGI > $100k. In Cohort 4, 84% resided in zip codes with AGI > $100k. Overall 70.4% of subjects identified as White, 8.3% Black or African American, 3.5% Asian, 4.4% Other, and 13.5% were unknown/or declined. African American/Black was most represented on Cohort 4 (11%), and least represented in Cohort 1 (5%). Conclusions: White patients comprise the largest proportion or PET scans whereas non-white groups are underrepresented across all cohorts. Access to PETs has appeared to improve for lower AGI, non-white patients following FDA approval and insurance coverage. It will be critical to assure equitable access across all demographic groups as deployment of PET scanning becomes the new standard of care.[Table: see text]