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PSMA-PET Adoption in US Prostate Cancer: Trends and Disparities

Publication Title: Adoption and Regional Variation of Prostate-Specific Membrane Antigen Positron Emission Tomography in the United States.

Summary

Question
This study examined the adoption and regional variation of prostate-specific membrane antigen positron emission tomography (PSMA-PET) imaging in the United States. The researchers aimed to assess the national utilization patterns of PSMA-PET following its approval in 2021 and to explore how geographic and sociodemographic factors influence its adoption.
Why it Matters
PSMA-PET is a precision imaging technique used to detect prostate cancer by targeting a protein (PSMA) commonly found on prostate cancer cells. Compared to traditional imaging methods, PSMA-PET offers higher accuracy in detecting cancer spread. Understanding how this technology is being adopted can help identify gaps in access and inform strategies to ensure equitable use. Given its influence on treatment decisions, widespread adoption of PSMA-PET has the potential to improve prostate cancer management but could also exacerbate existing disparities in healthcare access.
Methods
The researchers conducted a retrospective study using insurance claims data from Blue Cross Blue Shield (BCBS) covering over 514,000 men aged 40 to 89 diagnosed with prostate cancer between 2016 and 2024. They analyzed trends in PSMA-PET adoption and compared its use across different regions and demographic groups. Data were grouped into six-month intervals to track changes over time.
Key Findings
PSMA-PET use grew rapidly after its 2021 approval, becoming the dominant imaging method for prostate cancer by 2024. The number of patients undergoing PSMA-PET rose from less than 1 per 1,000 in 2021 to 77 per 1,000 in late 2024. Adoption rates were higher in regions with higher income and education levels. By contrast, use of older imaging methods, such as fluciclovine-PET, declined sharply. Significant regional variations were observed, with some areas reporting much higher PSMA-PET use than others.
Implications
The rapid adoption of PSMA-PET highlights its growing role in prostate cancer care. However, the findings also point to potential disparities, as regions with lower income and education had lower adoption rates. If PSMA-PET proves to improve outcomes, these disparities could worsen existing inequalities in prostate cancer care. Policymakers and healthcare providers may need to address barriers to access and ensure equitable distribution of this advanced imaging technology.
Next Steps
The authors recommend further research to evaluate the long-term clinical benefits of PSMA-PET in improving patient outcomes. They also suggest exploring strategies to reduce regional and sociodemographic disparities in access to this technology.
Funding Information
This research was supported by the U.S. Food and Drug Administration (FDA) of the U.S. Department of Health and Human Services (HHS) through financial assistance award U01FD005938. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the FDA/HHS or the U.S. Government. Yale University also provided funding and support for this research.

Full Citation

Leapman M, Long J, Westvold S, Rabil M, Sprenkle P, Kim I, Spilberg G, Saperstein L, Fallah J, Suzman D, Lerro C, Xu J, Rivera D, Kluetz P, Karnes R, Dinan M, Mitchell A, Kunst N, Wang S, Ma X, Gross C. Adoption and Regional Variation of Prostate-Specific Membrane Antigen Positron Emission Tomography in the United States. JCO Oncology Practice 2026, op2500617. PMID: 41632928, DOI: 10.1200/op-25-00617.
This AI-assisted summary has been reviewed and approved by at least one of the study's authors to ensure it accurately reflects the research.

Authors

  • Michael S. Leapman, MD, MHS

    First Author
    Yale School of Medicine

    Associate Professor of Urology

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  • Cary P Gross, MD

    Last Author
    Yale School of Medicine

    Professor of Medicine (General Medicine) and of Epidemiology (Chronic Diseases)

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Additional Yale School of Medicine Authors

Other Authors

  • Jessica B Long;
  • Jaleh Fallah;
  • Daniel Suzman;
  • Catherine C Lerro;
  • Jianjin Xu;
  • Donna R Rivera;
  • Paul G Kluetz;
  • R Jeffrey Karnes;
  • Aaron P Mitchell

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