Five‐year trends of bone scan and prostate‐specific membrane antigen positron emission tomography utilization in prostate cancer: A retrospective review in a private centre

Abstract

Introduction: In the last 5 years, there has been a significant focus on the use of positron emission tomography (PET) for primary and secondary staging of prostate cancer. In this study, we aim to describe the trends of use between Gallium-68 prostate-specific membrane antigen ligand (Ga-68 PSMA) PET/ computed tomography (PSMA PET/CT) and nuclear medicine bone scan (NMBS) for prostate cancer staging in the first institution in Australia to offer both modalities. Methods: We evaluated trends in prostate cancer staging/restaging imaging modalities at our facility between the time period January 2013-April 2018. Imaging logs were filtered to identify NMBS and PSMA PET/CT scans done within the time period for prostate cancer. Sub-analysis was undertaken (i) to investigate the number of patients who were imaged using both modalities, (ii) to compare the age of the patients in the NMBS group and the PSMA PET/ CT group and (iii) to compare the use of PSMA PET/CT for pre-treatment staging compared to the detection of recurrence or metastatic disease (secondary staging). Results: A total of 3144 examinations were performed in the time period reviewed, with 546 NMBS and 2598 PSMA PET/CT scans performed. In the 6 months after PSMA PET/CT was introduced, there was a 45.7% decrease in the number of NMBS performed and 95.3% decrease across the duration of the study. In the PSMA PET/CT cohort, 1569 examinations were performed for pre-treatment staging and 1029 performed for secondary staging. There was a significant difference in the proportion of PSMA PET/CT conducted for pretreatment staging compared with secondary staging when comparing the first and final 500 examinations (P < 0.05). Conclusion: After the introduction of PSMA PET/CT there was a marked decline in the use of NMBS for prostate cancer staging. This finding is of note as it occurred before there was clinical data or guidelines supporting the use of PSMA PET/CT for prostate cancer imaging.

Solitary rib lesions showing prostate‐specific membrane antigen (PSMA) uptake in pre‐treatment staging 68Ga‐PSMA‐11 positron emission tomography scans for men with prostate cancer: benign or malignant?

“…However, in many institutions, 68 Ga‐PSMA PET/CT has largely replaced conventional nuclear medicine bone scans and CT scans in the primary staging of prostate cancer [6]. Currently, at our institution, the ratio of 68 Ga‐PSMA PET/CT scans to conventional bone scans to investigate prostate cancer is approximately 53:1 [7].…”

Establishing a Provincial Registry for Recurrent Prostate Cancer: Providing Access to PSMA PET/CT in Ontario, Canada

“…This regulatory landscape allowed early roll out and adoption of PSMA PET technology by Australian physicians, as early as 2014. By 2015, PSMA PET became the primary mode of primary and secondary staging of prostate cancer (>90% of all patients) at an Australian center, despite a lack of clinical evidence supporting its use at the time ( 16 ). This approach has both pros and cons, and balancing the tradeoffs between the benefits of early adoption and threshold of evidence required is something that every public-health system must decide for itself.…”

Patterns of primary staging for newly diagnosed prostate cancer in the era of prostate specific membrane antigen positron emission tomography: A population‐based analysis

“…These results are corroborated by recent literature suggesting declining use of whole body bone scan and rising use of PSMA PET/CT in prostate cancer assessment. 17 The increased utilisation of such imaging is likely secondary to increased awareness and confidence in this imaging modality. This may be in part due to the early adoption and prolonged clinical experience of PSMA PET/ CT within Australia.…”