African American Men with Prostate Cancer Have Less Access to Cutting-Edge PET Care

Access to a better-performing radiotracer is limited among African American men who are undergoing treatment for recurrent prostate cancer, according to a newly published study.

While ¹⁸F-fluciclovine is used more frequently with prostate cancer patients, evidence shows ⁶⁸Ga-prostate specific membrane antigen (PSMA) performs better, said a team from the University of California at San Francisco (UCSF), led by Matthew Bucknor, M.D., associate professor of radiology. But, not everyone has the same access.

In their study published Sept. 25 in the Journal of Nuclear Medicine, Bucknor’s team shared that, even though African American men develop prostate cancer at higher rates and are more likely to die from the disease, they do not have the same level of access to the latest, most effective treatments.

“Recent studies have shown that ⁶⁸Ga-PSMA-11 offers significantly improved detection rates compared to ¹⁸F-fluciclovine,” Bucknor’s team wrote. “However, ⁶⁸Ga-PSMA-11 is not yet [FDA] approved and has only been accessible in the U.S. through clinical trials.”

Given that, the team set out to identify whether there were any potential obstacles that could be contributing to disparities in prostate cancer outcomes. At this point, ⁶⁸Ga-PSMA-11 is still considered to be investigational and can only be administered to patients who are part of an approved clinical trial.

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In an effort to figure out how easily African American men with prostate cancer can access this investigational radiotracer, Bucknor’s team analyzed all ¹⁸F-fluciclovine and ⁶⁸Ga-PSMA-11 PET scans conducted at UCSF between October 2015 and January 2020. This group included 1,756 patients – 1,502 who underwent ⁶⁸Ga-PSMA-11 imaging and 254 who underwent ¹⁸F-fluciclovine scans. In addition, the team looked at a patient’s race and ethnicity, primary language, body mass index, and insurance coverage. They also considered home addresses and used them to determine a patient’s socioeconomic status.

Based on their analysis, the team discovered African American men are nearly four times as likely (OR 3.88) to have a ¹⁸F-fluciclovine PET scan than are their white counterparts. However, the team did not find any statistically significant demographics factors between these patient populations. At the same time, Bucknor and his colleagues found that six times as many men were imaged with ⁶⁸Ga-PSMA-11 – even though clinical trial participation was mandated for access to the radiotracer. This result, they said, could highlight possible disparities in access to imaging trials among African American men.

Because the reasons for these disparities remain nebulous, the team said, the industry should begin work to combat the disparities. Providers should be aware that unconscious racial bias could be a factor, the team warned.

In particular, they noted, additional studies similar to their own are necessary so the industry can develop well informed policies and procedures that can break down disparities and pave the way for more equitable care.