The Influence of the Introduction of PSMA-PET/CT in Danish Men Diagnosed with Prostate Cancer

BACKGROUND: Conventional imaging in patients with newly diagnosed prostate cancer is gradually being replaced with PSMA-PET/CT. However, the possible impact of newer imaging modalities on stage migration is poorly understood. We have studied the effects of introducing PSMA-PET/CT on the incidence of newly diagnosed hormone-sensitive prostate cancer.

PATIENTS AND METHODS: This population-based nationwide study included all Danish men born between 1920 and 1970 and diagnosed with prostate cancer between 2010 and 2022 (N = 58,635). Information on prostate cancer diagnosis and diagnostic workup was retrieved from prospectively maintained nationwide registries. Cause of death was retrieved until the last date of follow-up (August 11, 2024). Multivariable linear regression, logistic regression, and Cause-specific Cox proportional hazards were utilized to obtain estimates.

RESULTS: Each PSMA-PET/CT performed increased the number of metastatic diagnoses by 0.29 (95% confidence interval [CI]: 0.21-0.38, P < .001), primarily driven by regions with a higher use of PSMA-PET/CT. Having PSMA-PET/CT performed increased the likelihood of having the therapies radiation to the prostate in an oligometastatic setting (Odds ratio: 4.1, 95% CI: 3.5-4.9) or chemotherapy (Odds ratio: 1.27, 95% CI: 1.04-1.56). Five-year prostate cancer-specific mortality in all men diagnosed with prostate cancer decreased only in areas with high PSMA-PET/CT usage, from 15% (95% CI: 14-16) when diagnosed in 2010 to 2014 to 13% (95% CI: 12-14) when diagnosed in 2019 to 2022.

CONCLUSION: Our data shows that the implementation of PSMA-PET/CT on a nationwide level led to prostate cancer stage migration, coinciding with a slight decrease in prostate cancer-specific mortality in regions with the highest usage of PSMA-PET/CT.