Prostate-Specific Membrane Antigen PET-CT Imaging for the Staging of Prostate Cancer in Canada

Abstract


 Health Canada approved the first prostate-specific membrane antigen (PSMA)-PET radiopharmaceutical in October 2022 for the staging of PSMA-positive lesions in those with prostate cancer. Health Canada also approved a lutetium-177 PSMA-617 therapy for patients with advanced PSMA-positive metastatic castration-resistant prostate cancer in September 2022, a therapy for which patient eligibility is identified with a gallium-68 PSMA-PET exam.
 With 57 PET-CT units in 9 provinces, access to PET-CT may be limited by the health care system’s capacity to conduct these exams due to wait lists, competing clinical priorities, and staff shortages.
 It is anticipated that the public funding of PSMA-PET across Canada will increase existing demand for PET-CT by a minimum of 23%.
 The provision of PSMA-PET would occur within the context of managing competing new demands for this service that could double existing exam volume.
 Sufficient staffing is needed to ensure sustainable operation and development of PET-CT services, supported by investment in the workforce through education and training opportunities.
 There is potential to increase the hours of operation of PET-CT units in many facilities, with consideration to the many dependencies, including staffing and the fact that the operating times of PET-CT units are closely tied to the operating times of the cyclotrons that supply the radiopharmaceuticals used in PET-CT exams.
 The upfront capital and ongoing operational costs of PET-CT, radiopharmaceutical products, and equipment may act as barriers to the further adoption of this technology.
 A combination of both generator-produced and cyclotron-produced PSMA-PET radiopharmaceuticals will likely be needed to meet the geography of Canadian jurisdictions and to secure a reliable and resilient supply chain.