Background/Aim: Although prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is recommended for staging high risk prostate cancer (PCa), recently, it has demonstrated a good accuracy to guide targeted biopsy for the diagnosis of PCa. In this study we evaluated the cost-effectiveness of PSMA PET/CT as single procedure for diagnosis and staging high grade PCa. Patients and Methods: From June 2022 to June 2025 300 men (median age=65 years) underwent transperineal prostate biopsy at Cannizzaro Hospital (Catania, Italy) for suspicion of high grade PCa (PSA ≥20 ng/ml) and/or suspicious digital rectal examination (DRE). All the patients underwent PSMA PET/CT and intraprostatic lesions with a standard uptake value (SUVmax) ≥8 were submitted to targeted biopsies plus extended prostate biopsy. The overall cost of prostate biopsy was calculated using the Italian National Public Health System “Day Service” and “out of pocket” by market research to evaluate the cost of PSMA PET/CT, multiparametric magnetic resonance image (mpMRI), lung and abdominal CT and bone scan. Results: Median PSA was 29.6 ng/ml (range=20-785 ng/ml) and 135/300 (45%) had positive DRE; a clinically significant PCa was found in 295/300 (98.3%) patients and 270/295 (91.5%) had a Gleason score ≥8/ISUP Grade Group ≥4. Clinical staging by PSMA PET/CT demonstrated: 125 (42.3%) cT2PCa vs. 170 (57.3%) cT3PCa cases; in detail, 86/295 (29.1%) had positive nodes, 42 (14.2%) bone metastases and 29 (9.8%) multiple metastases. The overall cost of the 300 prostate biopsies calculated using the Day Service model was 57,120€; conversely, the cost “out of pocket” of PSMA PET/CT would have been equal to 300,000/450,000€ and its exclusive use would have spared 103,000/300,000€ (25.5-40%) equal to the cost of mpMRI, bone scan, CT and staff trained to perform procedures reducing time of diagnosis and staging from a median of 90 to 45 days. Conclusion: PSMA PET/CT for diagnosis and staging as a single imaging procedure in men with suspicion high grade PCa, improved cost-effectiveness by reducing cost (25.5-40%), time to the diagnosis and staging, whilst allowing for timely therapy initiation in men with high risk of metastases.
Pepe et al. (Fri,) studied this question.