Real-world PET PSMA imaging patterns in a Chicago safety-net hospital.
Authors: Pothen Joshua , . Aseem , Sauer Calvo Ruben , Krule Alex , Chandran Shaeker , Chuy Valerie , Mohamed Salimah , Tawagi Karine , Reizine Natalie Marie 
Published: July 2024

e17009

Background: Prostate-specific membrane antigen positron emission tomography (PSMA PET) imaging is an FDA-approved imaging modality with increased sensitivity for prostate cancer (PCa) detection. It thus can more accurately stage patients to determine optimal initial treatment. However, patients with indications for these scans can still experience significant delays in obtaining them, mainly due to insurance denials. Such delays often disproportionately affect those with healthcare disparities, representing a substantial population at University of Illinois Chicago (UIC), a safety-net hospital. We sought to identify patterns, barriers, & areas for improvement in obtaining this guideline-directed imaging modality. Methods: PCa patients with a PSMA PET scan ordered between January 2021 and June 2023 were included for analysis. Key medical and demographic data such as age, race/ethnicity, and insurance status were obtained. We also determined the time between ordering and obtaining the PSMA PET, and whether the scan led to classifying the patient’s disease as clinically localized, regional, or metastatic. We also determined whether subsequent treatment was curative or palliative intent. The dates and types of other imaging modalities, if obtained, were also recorded. Results: We identified 76 patients with PSMA PET scans ordered during the study timeframe. The mean age was 68.6 years, with a standard deviation of 7.3 years. 60.0% identified as Black or African American, 24.0% as White, 4.0% as Asian, and 1.3% as American Indian or Alaska Native. 40.8% had Illinois Medicare as their primary insurance, 27.6% had Medicaid, and 31.6% had another medical insurance. Most individuals (77.6%) had a delay in obtaining their PSMA PET scan, with a median time to scan of 23.0 days (range 6-136). All insurance types, including Illinois Medicare, Medicaid, and private insurance, had delays (74.2%, 81.0% and 79.2% of all PSMA PETs, respectively). Many delayed individuals also received conventional imaging (46.0%) within 3 months of the PSMA PET scan order as part of their workup, with 40.0% of PSMA PETs revealing new findings compared to the other scans. Ultimately, most of the imaged patients (54.0%) were determined to have regional or metastatic PCa. Delays in obtaining and receiving the results of scans affected individuals who underwent both curative (40.8%) as well as palliative intent (46.1%) treatment. Conclusions: Between January 2021 and June 2023, PCa patients had a median delay of approximately three weeks in obtaining a PSMA PET scan that was ordered urgently for the determination of their PCa treatment. Such delays can significantly impact health outcomes and often result in redundant conventional imaging. This retrospective study represents the first step in a quality improvement project to reduce delays to PSMA PETs and enable the development of a timely treatment plan to improve patient outcomes in our diverse patient population.