Zachary Klaassen: Hello, UroToday, thanks so much for joining us. My name is Zach Klaassen, I'm a urologic oncologist at the Georgia Cancer Center in Augusta, Georgia. I'm delighted to be joined for an ASCO 2025 presentation by Eunice Hankinson, who is a nurse practitioner, clinical director at Flatiron Health. Today we're going to be discussing her ASCO 2025 presentation, Assessment of Racial/Ethnic Inequities and Uptake of PSMA-PET Imaging Among Patients with Metastatic Prostate Cancer in the United States. Eunice, thank you for joining us on UroToday to discuss your research.

Eunice Hankinson: Thank you so much, Zach. Thank you so much UroToday for having me on today. I'm really excited to present our work on Assessment of Racial and Ethnic Inequities in Uptake of PSMA-PET Imaging Among Patients with Metastatic Prostate Cancer in the United States. Overall, our study found that there is lower usage of PSMA-PET among patients who are Black and Latinx patients.

So our cohort in this study used Flatiron Health data, which is a de-identified database that uses electronic health records in order to identify patients. It is a retrospective study that included adult patients who were diagnosed with metastatic prostate cancer between December 2020 and May 2024. We randomly selected the patients. There were 250 non-Hispanic white patients included, 250 non-Hispanic Black patients included, and 50 Latinx patients. And the reason for including the 50 Latinx patients was that these patients were included for exploratory analysis, and that was really just based on time to be able to abstract all patients in the cohort. So after selecting the patients, we manually reviewed the patient charts by human abstractors to confirm that these patients did have PSMA-PET imaging or did not have PSMA-PET imaging within the timeframe of December 2020 and May 2024.

So we did find that non-Hispanic white patients were more likely to have PSMA-PET scans done compared to non-Hispanic Black and Latinx patients. 61.2% of non-Hispanic white patients had a PSMA-PET scan. That number reduces to 50% in non-Hispanic Black patients and only 38% in Latinx patients.

So in summary, in this cohort of 550 patients with metastatic prostate cancer, we found that 54% of patients overall had a PSMA-PET scan, and we do see that there's increased utilization of PSMA-PET scan over the years. However, the non-Hispanic Black patients were 44% less likely to have a PSMA-PET scan and then the Latinx patients were 63% less likely to have a PSMA-PET scan compared to non-Hispanic white patients. This underscores the significant racial and ethnic disparities in uptake of PSMA-PET scan and future research should really explore the drivers of these racial and ethnic differences in PSMA uptake and their potential impact on patient outcomes.

And so really the take-home message is that these findings raise urgent concerns about equity in diagnostic imaging, and then they highlight the need for systemic change to ensure that all patients, regardless of their racial or ethnic background, have access to advanced diagnostic technologies.

Zachary Klaassen: Eunice, great presentation and congratulations on the great work presented at ASCO 2025. I guess my first question is, and it may be somewhat difficult to answer, but why do you think we're seeing these disparities among the minority patients? It's probably multifactorial, but what are your thoughts?

Eunice Hankinson: Yeah, I do think it's multifactorial and I do think actually, it's really hard to quantify all the reasons why this could be happening. But I do think that it's important that when we are talking about the underutilization of PSMA-PET scan, is that we talk about the care of prostate cancer broadly for patients in general. Where we do see disparities in care for patients with prostate cancer overall, I think that these differences in care aren't just about imaging. They're closely tied to larger systemic issues that impact how patients with prostate cancer access and receive treatment.

So we know that care delivery can vary significantly across demographic groups and that a lot of this is shaped by social determinants of health. So social determinants of health are things like income, education, insurance coverage, neighborhood conditions and geographic locations play a role.

So tying this back in with the PSMA-PET underutilization, I think one major challenge is that PSMA-PET facilities just aren't located everywhere and often they're not in places where marginalized communities can easily access them, and that geographic barrier alone creates major inequities in who can actually benefit from this kind of imaging.

I think in some areas, patients have to travel for long distances or deal with fragmented referral systems just to get to a center that offers PSMA-PET. So that, I think, coupled with all those factors can cause delays in diagnosis or treatment, and I think it is one major way how disparity shows up in real and tangible ways.

Zachary Klaassen: Yeah, it's a great answer. When I look at my patient population in Georgia, about half of my advanced prostate cancer patients are minorities, but they're getting to my clinic one way or the other. So obviously when I see them, they get a PSMA-PET scan. But you're right, I don't know what the denominator is of the patients that aren't necessarily getting to my clinic that probably aren't getting PSMA-PET scans. So that makes sense. I like your point about the locations of the scanners and locations of those clinics may be difficult to get to.

Eunice Hankinson: Yeah, and the first PSMA-PET radiotracer agent was studied at UCLA, and so even when we start looking at this in 2020, some of those PSMA-PET agents were really being used around that UCLA area, and that has expanded now, but I really do think that location is a really big barrier for patients.

Zachary Klaassen: Yeah, great point. When you look at your data, you have a lot of great jumping off points to move things forward. How do you take this data and maybe start to help raise awareness or more importantly, get the PSMA-PET scans into the patients that really need them?

Eunice Hankinson: I think that's a great question, and I think one of the most important steps is really using high quality real world data, like Flatiron, because we can gather information to better understand where these disparities are happening outside of clinical trials, but in actually real world settings. So I think that's a major asset that we can use to understand what's happening in routine clinical practice. And then with this information, then we can start to truly identify the specific gaps, whether it's those geographic access locations that we've talked about, whether it's referral patterns or differences in treatment pathways, and then tailor interventions accordingly. I think it helps to inform provider education. It can help with community engagement strategies that ensure that newer technologies like PSMA-PET scan are reaching all patients equitably and not just those in more resourced or connected settings.

Zachary Klaassen: Yeah, great point. I think you nailed it. The quality of the data and the abstraction that you guys did to confirm all these things. I mean, it's easy to do ICD-10 codes or CPT codes, but really doing a deep dive to make sure we're getting good quality information to base those hypotheses around is excellent. Again, fantastic work. Anything we haven't hit on? Any take home messages you want to leave our listeners before we wrap up?

Eunice Hankinson: Yeah, thank you. I definitely do want to wrap up and have this take home message. Although our study found clear disparities in PSMA-PET use among patients with metastatic prostate cancer, I think we need more studies beyond this study. I think we need further studies to understand what's driving these racial and ethnic differences in uptake, whether that's access, provider practices, patient level factors, or systemic barriers. And then I also think we need further research to help us contextualize what this means for patients. So how are these delays or lack of access to PSMA-PET ultimately impacting patient outcomes, including their survival?

Zachary Klaassen: Yeah, absolutely, well said. Eunice, thanks for joining us on UroToday, taking time out of your day and sharing this great information with our listeners.

Eunice Hankinson: Thank you so much, Zach.