(UroToday.com) The 2025 ASCO annual meeting featured a prostate cancer session and a presentation by Eunice Hankinson discussing an assessment of racial/ethnic inequities in uptake of PSMA-PET imaging among patients with metastatic prostate cancer in the United States. PSMA-PET imaging has transformed the diagnosis and treatment of prostate cancer since 2020 given that it can detect smaller prostate cancer lesions earlier than conventional imaging. Racial/ethnic inequities in prostate cancer are well documented, yet little is known about the extent of inequities in PSMA-PET use in patients with prostate cancer. For this ASCO 2025 presentation, the investigators examined PSMA-PET uptake among non-Latinx/Hispanic White, Black, and Latinx/Hispanic patients with metastatic prostate cancer to identify racial/ethnic differences in PSMA-PET use.
This retrospective study included adults diagnosed with metastatic prostate cancer between December 2020 and May 2024 from the US nationwide Flatiron Health electronic health record-derived, deidentified database. Receipt of PSMA-PET was determined by manually reviewing unstructured EHR data. The investigators selected non-Latinx/Hispanic White and Black patients using race/ethnicity-stratified random sampling, to detect an absolute difference of ≥7% in the proportion of patients with a PSMA-PET scan (80% power, α = 0.05). Due to limitations in cohort size, Latinx patients were included in exploratory analyses. To assess the relationship between race/ethnicity and PSMA-PET uptake, they used multivariable logistic regression adjusted for age and metastatic prostate cancer diagnosis year. Socioeconomic status, a mediator, was excluded as a covariate per the Institute of Medicine framework.
The cohort consisted of 550 patients: 250 non-Latinx/Hispanic White patients, 250 Black patients, and 50 Latinx patients. More than half (54.0%) of patients had at least 1 documented PSMA-PET scan, with steadily increasing PSMA-PET utilization observed between 2021 (33.3%) and 2023 (64.9%). Compared with non-Latinx/Hispanic White patients, Black patients and Latinx patients were more likely to have a lower socioeconomic status. Black patients were also more likely to be younger than non-Latinx/Hispanic White and Latinx patients. The majority (88.9%) of initial scans were completed after the metastatic prostate cancer diagnosis date, with 75.0% of scans occurring in the hormone-sensitive setting compared with 24.7% in the castration-resistant setting. Compared with non-Latinx/Hispanic White patients, Black patients had lower PSMA-PET utilization rates (61.2% versus 50.0%; adjusted OR 0.56, 95% CI, 0.38-0.82). PSMA-PET utilization rates were also lower among Latinx patients (38.0%) relative to non-Latinx/Hispanic White patients (adjusted OR 0.37, 95% CI, 0.19-0.71).
Eunice Hankinson concluded her presentation discussing an assessment of racial/ethnic inequities in uptake of PSMA-PET imaging among patients with metastatic prostate cancer in the United States with the following take home points:
- This study showed racial/ethnic differences in the use of PSMA-PET among patients with metastatic prostate cancer
- Black and Latinx patients were less likely to receive PSMA-PET imaging than non-Latinx/Hispanic White patients
- These results are consistent with prior research documenting racial/ethnic inequities in the adoption of medical innovations and highlight the need for interventions to promote equitable uptake of diagnostic tools in oncology
- Future research should explore potential drivers of racial/ethnic differences in PSMA-PET uptake and their potential impact on patient outcomes
Presented by: Eunice Hankinson, Flatiron Health, New York, NY
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the American Society of Clinical Oncology (ASCO) 2025 Annual Meeting, Chicago, IL, Fri, May 30 – Tues, Jun 3, 2025.
Related content: Study Examines Racial Disparities in PSMA-PET Imaging Utilization for Metastatic Prostate Cancer - Eunice Hankinson