New technology makes PET scans find prostate cancer better

By David Eagle, MD | February 17, 2022

In the United States, one man in eight will be diagnosed with prostate cancer.  Last year, approximately 270,000 men were diagnosed with prostate cancer and approximately 35,000 died of the disease. Thankfully, we are making progress on multiple fronts. Prostate cancer screening can save lives. Men with cancer localized to the prostate gland can be cured with surgery or radiation therapy. Patients with more advanced disease have multiple therapy options that were simply not available 10 years ago – targeted therapy to block hormone pathways, immunotherapy, therapy to target genetic tumor defects, chemotherapy and more. It makes a difference – patients are living longer.

One exciting new advance belongs to a category of technology called theranostics.  This uses special biologic molecules to help X-ray studies detect small amounts of prostate cancer.  The latest example is PSMA PET scanning.  This technology uses a special molecule to make PET scans find prostate cancer better. This more accurate information helps doctors decide which patients are more likely to benefit from surgery or radiation therapy for localized disease. It also helps doctors find recurrences if a patient’s PSA begins to rise after initial treatment.

New technologies can only help patients if patients have access to them.  Unfortunately, this is not the case for PSMA PET scanning. Reimbursement rules and the amounts paid for the agents for PSMA PET scanning are determined by regional Medicare bureaucracies known as Medicare Administrative Contractors – MACs. New York’s MAC region is run by a company called National Governmental Services. Currently, this agency has set reimbursement rates for the special agents that make PSMA PET scanning possible below the true costs of the cancer centers that use them. Therefore, clinics cannot use them and patients in need do not have access to a study that may help save their lives.

It doesn’t have to be this way. The same MAC reimburses similar agents in a way that allows cancer clinics to provide the services to patients.  A simple change to the reimbursement formula for PSMA PET scanning to match these other agents would allow New York prostate cancer patients to access the best and latest technology to fight their disease.

David Eagle, MD is Chair of Legislative Affairs and Patient Advocacy at New York Cancer & Blood Specialists.