Impact of geographic and demographic characteristics on treatment with Lu-PSMA for metastatic castrate-resistant prostate cancer (mCRPC).
Authors: Pepin Abigail , Doucette Abigail , Takvorian Samuel U , Narayan Vivek , O'Brien Sophia , Mankoff David A. , Mulugeta Philipose , Pryma Daniel A. , Taunk Neil 
Published: February 2025

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Background:
Metastatic castration-resistant prostate cancer (mCRPC) remains an incurable and fatal disease. Administration of Lu-PSMA demonstrates improved progression free survival and overall survival in this population (1). Despite this, understanding patient access to and receipt of this therapy is understudied. We aim to characterize the demographics of patients receiving Lu-PSMA at a NCI-designated medical center in Philadelphia, PA after FDA approval.
Methods:
All patients treated at a single institutional center with Lu-PSMA from April 2023 to October 2024 were included. Demographic characteristics including age at first treatment, race, insurance status, and zip code were extracted from the medical record. Travel distance between a patient’s home and a treatment center was calculated using the Haversine formula as provided by the National Bureau of Economic Research. Median household income was obtained by US Census 2022 American Community Survey. All analyses were performed on Prism (GraphPad, v 10.3.1).
Results:
A total of 103 patients were included for analysis. The median age at time of first Lu-PSMA treatment was 73 years (range 50-92). 71.8% (n=74) were white and 28.2% were non-white (n=21 Black/African American; n=8 other/multiracial/unknown). All patients were non-Hispanic. All patients were insured (77.7%, n=80, Medicare/Managed Medicare; 3.9%, n=4, Medicaid/managed Medicaid; 18.4%, n=19, private/other insurance). Median distance travelled to a treatment center was 12 miles. About one quarter of patients travelled >25 miles to reach their treatment center (42.7%, n=44, <10 miles; 32.0%, n=33, 10-25 miles; 9.7%, n=10, 25-50 miles; 11.7%, n=12, 50-100 miles; and 3.9%, n=4, >100 miles). Most patients resided in an urban zip code, with a minority (4.9%, n=5) residing in a rural zip code. The median household income by zip code varied from $30,946 to $233,194 (9.7%, n=10, $30-50K; 18.4%, n=19, $50-75K; 20.4%, n=21, $75-100K; 39.8%, n=41, $100-150K; 11.7%, n=12, >150K). The number of Lu-PSMA treatments received was not correlated with distance travelled (F(4,98)=2.4, p=0.05), median household income (F(4,98)=0.5260, p=0.72), or race (p=0.83). There were no differences in travel distance between white and non-white patients (p=0.24). On Kaplan Meier, there were no differences in overall survival in patients that travelled >12 miles for treatment versus those who resided <12 miles from a treatment center (p=0.48). There were no differences in overall survival by race between white with non-white patients (p=0.66).
Conclusions:
Receipt of Lu-PSMA was not different in populations separated by race, distance to treatment center, or median household income. Increasing travel distance was not associated with receipt of fewer cycles of treatment. Further analysis is needed on whether these factors are associated with referral for and acceptance of Lu-PSMA. 1. Sartor
NEJM
2021.